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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00037645 Site Location: 2808 COUNTRY CLUB BLVD Account ID. AR0021257 <br /> Receivedby EE0004636 BACKUS Received Date: 2/27/2014 Print Date: 2/27/2014 9:02:45AM <br /> Assigned To: EE0004636 BACKUS Assigned Date: 2/27/2014 <br /> Program/Element Code:1619-RETAIL MKT>1000 SQ FT(=/>2 DEPTS) <br /> Complainant: :BATTALION CHIEF VAN RIVIERE-STOCKTON FIRE Home Phone <br /> Address _ Work Phone 209-464- bO <br /> Mail Address <br /> Nature of complaint: <br /> SMOKE FROM UNKNOWN SOURCE IN STORE. STOCKTON FIRE DEPT REQUESTED EHD RESPONSE. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0012734-Safeway Store 1769 Owner: OW0009849-Safeway,Inc <br /> Site Location 2808 Country Club Blvd RP/DBA SAFEWAY STORE#1769 <br /> Stockton,CA 95204 RP Address 5918 STONERIDGE MALL RD <br /> Cross Street PLEASANTON,CA 94588-3229 <br /> Mailing Address: 5918 Stoneridge Mall Rd. Billing Address 5918 Stoneridge Mall Rd. <br /> Pleasanton,CA 94588 Pleasanton,CA 94588 <br /> Home Phone :925-467-3845 <br /> Phone :925-467-3000 EXT: Work Phone :925-467-3000 EXT: <br /> District Location Code <br /> APN <br /> Date Abated Z^.Z�_I Inspector ID#: <br /> G[n 4 <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: C) I <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE # <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints -SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104 rpt <br />