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µ. � Complaint Investigation Form Report#:5104 <br /> COMPLAINTID: C00032468 Site Location: 2824 FARMINGTON RD Account ID: <br /> Received by: EE0001420 MENDE Received Date: 8/1312010 Print Date: 8/16/2010 10:40:01 AM <br /> Assigned To: F-E0001420 MENDE Assigned Date: 8/16/2010 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: :MELISSA MENDE,EHD Home Phone <br /> Address Work Phone ; <br /> E-Mail Address <br /> Nature of com Taint: <br /> FACILITY IS OPERATING WITHOUT HEALTH PERMIT. <br /> Complaint Mode: O Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail!Correspondence O-Other EH Unit P-Phone <br /> I-Intemet/Email S-Sheriffs Office . <br /> --------------- ----------------------------------- <br /> FACILITY <br /> — -------------- ---- ------ —FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002077-S MARKET Owner: OW0003922-THAO,KA <br /> Site Location 2824 RMINGTON RDS A RP/DBA <br /> STOCK N,CA 95205 RP Address 3709 ANGELINNA•L'N <br /> Cross Street ` STOCKTON;CA 95212 <br /> Mailing Address: 2824 FARMINGTON RD STB A p Billing Address 3709 ELINA LN <br /> STOCKTO ,CA 9205 G STO TON,CA 95212 <br /> Home Phone :2 -475 0574 <br /> Phone :209-467-4106 Work Phone <br /> District 004-VOGEL,KEN Location Code 99-UNINCORPORATED AREA <br /> APN 17306036 �1 <br /> Date Abated �/f L,i 1i11 Inspector: <br /> 7 ----------- ---- <br /> Send Referral to Referral Letter Sent by — <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement RegiredSee Program Record File <br /> 03-NAI 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 /> 07-REFERRED TO OTHER AGENCY <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 /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 510p.rpi <br />