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a > <br /> ''. Complaint Investigation Form Report#:5104 <br /> COMPLAINTAD: C00032077 Site Location: 25520 E HWY 4 Account ID, AR0000066 <br /> r?eeeived by: EE0009058 LOW E Received Date: 5/20/2010 Print Date: 5/20/2014 4:06:10PM <br /> Assigned To: EE0001420 MENDE Assigned Date: 5/20/2010 <br /> Pro.gram/Element Code:1600-FOOD PROGRAM <br /> Complainant: : � v Nome Phone : 209-886-5112 <br /> Address 1 v Work Phone ; <br /> E-Mail Address 1 <br /> Nature of com laint: l <br /> (C}STATED TODAY AT 3:05 PM,OWNER WAS BARBECUING ON PORCH OF STORE. FOOD TO BE SOLD INSIDE OF STORE. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Intemet!Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000067-FARMINGTON GEN STORE Owner: OW0000056-KAUR,KARMALfIT <br /> Site Location 25520E HWY 4 RP/DBA FARMINGTON GENERAL STORE <br /> FARMWGT ,CA 95230 RPAddress 1708 AVIGNON LN <br /> Cross Street HWY 4 MODESTO,CA 95356 <br /> Mailing Address: 170 AVIGNON LN � Billing Address 1708 AVIGNON LN <br /> DESTO,CA 95356 rcMODESTO,CA 95356 <br /> {� r Home Phone :209-495-6992 EXT: CELL <br /> Phone ;209-886-5544 L�- Work Phone :209-886-5544 <br /> District 004-VOGEL,KEN X� Location Code 99-UNINCORPORATED AREA <br /> APN 18722001 <br /> Date Abated ©- [J Inspector. <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint History <br /> Attached But Not <br /> Complaint Status Code: Scanned <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAb Abatement Regired-See Program Record File <br /> 03-NRI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> REFERRED TO OTHER AGENCY <br /> UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29-FOODBORNE ILLNESS-Major Violations Edentified <br /> 51 4.rpt <br />