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Complaint Investigation Form Report*5104 <br /> COMPLAINT ID: 000037818 Site Location: 235 E FREMONT ST Account JD AR0001465 <br /> Receivedby. EE0008999 HUYNH Received Date: 4/812014 Print Date, 4!8/2014 4:36:32PM <br /> Assigned To EE0008999 HUYNH Assigned Date: 41812014 <br /> ProdramJElement Code 1600-FOOD PROGRAM <br /> Complainant. : <br /> <br /> <br /> Nature of com faint: <br /> SMOKING IN FACILITY WITH EMPLOYEES, REFER TO STOCKTON PD. <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 i Correspondence O-Other EH Unit P-Phone <br /> I-Inlemet l Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:J"A0001466-STORE,THE Owner. OW0001 147-UHL,CHARLES J <br /> Site Location 235 E FREMONT ST RP DBA THE STORE <br /> STOCKTON,CA 95202 RP Address 8039THORNTON RD <br /> Cross Street FREMONT STOCKTON,CA 95203 <br /> Mailing Address: 235 E FREMONT ST Billing Address 8039 THORNTON RD <br /> STOCKTON.CA 95202 STOCKTON,CA 95203 <br /> Home Phone 209-922-6784 <br /> Phone :209-467-8673 Work Phone :209-467-8673 EXT: BUSINESS <br /> District 001-VILLA PUDUA Location Code <br /> APN 13906034 <br /> Date Abated — L / Inspector ID <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date. <br /> Complaint Status Code: 1 j— <br /> Circle appropriate Status Code <br /> 15-ACTIVE HO USING 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-.JAI SENT 50-LEAD Assessmen t 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 />