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s #^ ,, y9ov N— Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: 000045954 Site Location: 2824 FARMINGTON RD STE B Account ID: AR0037050 <br /> Receivedby: EE0008999 HUYNH Received Date: 3/12/2018 Print Date: 3/12/2018 4:34:31PM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 3/12/2018 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :LEYNA HUYNH Home Phone <br /> Address : 1868 E HAZELTON AVE Work Phone 209-468-3446 <br /> STOCKTON,CA 95205 E-Mail Address <br /> Nature of complaint: <br /> FIRE AT THE FACILITY <br /> Complaint Mode.: O 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-Inlemet/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0020665-99 PLUS&CIGARETTE SHOP Owner: OW0016982-ALFARAH,HUMZA <br /> Site Location 2824 FARMINGTON RD STE B RPIDBA 99 PLUS&CIGARETTE SHOP <br /> STOCKTON,CA 95205 RP Address 16802 TRAIN STATION CT <br /> Cross Street MARIPOSA LATHROP,CA 95330 <br /> Mailing Address: 2824 FARMINGTON RD STE B Billing Address 16802 TRAIN STATION CT <br /> STOCKTON,CA 95205 LATHROP,CA 95330 <br /> Home Phone :209-407-9391 EXT: CELL <br /> Phone :209-943.3050 Work Phone <br /> District 001-VILLAPUDUA,CARLOS Location Code 01-STOCKTON <br /> APN 17306036 ,y,- <br /> `r` <br /> Date Abated �j/�2It Inspector ID#: it �4 <br /> ------------------------------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: V <br /> Circle appropriate Status Code , <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-ReOerred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> omp aint Reviewed by: I A uate: pate y: ate:�j u <br /> 5104.rpt <br />