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, a <br /> r Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000015576 Site Location: 224 W KETTLEMAN LN account ID: AR0000723 <br /> Received by: EE0000099 Frost Received Date: 3/1/2001 <br /> Assigned To: EE0000467 CARRUESCO Assigned Date: 3/1101 is <br /> i <br /> Pr gram/Element Code: 9625-RESTAURANTIBAR 51-100 SEATS <br /> <br /> <br /> <br /> Nature of complaint: <br /> 2-28-01 COMPLAINANT AND 9 YEAR OLD DAUGHTER WENT THROUGH DRIVE THRU PURCHASED HAPPY MEAL AND STRAWBERRY <br /> SODA.WENT HOME DAUGHTER DRANK SODA AND FOUND IT INFESTED WITH ANTS.CONTACTED POISON CONTROL BECAUSE OF <br /> ARSENIC OR ANT POISON. <.} <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council.,` E-Code Enforcement <br /> M-Mail/Correspondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0000724-KENTUCKY FRIED CHICKEN#120 Owner: OW0006092-HARMAN-DAVE&LISA INC <br /> RP/DBA: KENTUCKY FRIED CHICKEN#120 <br /> Site Location: 224 W KETTLEMAN LN i <br /> RP Address: 5544 S GREEN ST <br /> LODI,CA 95240 <br /> MURRAY,UT 84123-5798 <br /> Mailing Address: 5544 S GREEN ST 4 i <br /> MURRAY, UT 84123-5798 Billing Address:: 5544 S GREEN ST ;'. ' <br /> MURRAY, UT 84123-5.798 <br /> Phone: 1st: 415-727-0163 Phone. 1 <br /> Wk: 801-486-2300 <br /> i <br /> District 004-SEIGLOCK,JACK Location Code 02-LODI <br /> APN <br /> I' <br /> Date Abated 3 — 1 -o <br /> Inspector <br /> i <br /> I <br /> Send Referral to: <br /> Referral Address: <br /> 1' <br /> ii <br /> I• <br /> Referral Letter Sent by: ! <br /> Date: I <br /> Complaint Status Code: <br /> 01 -Field Abated 10-Substandard Property-See HOUSING ABATEMENT File <br /> 02-Office Abated 15-Active Housing Case-New Complaint See Active Case# <br /> 03-NAI Sent 16-Letter Sent To Tenant I. <br /> 04-Notice To Abate Issued 17-15-Day Letter Sent <br /> 05-EnforcementAction Initiated 50-Lead Hazard Evaluation Required(1) <br /> t'4Ebj EHD Permit Facility-See Linked Premise File 52-Lead Hazard Abatement in Progress(3) <br /> `07 Referred To Other Agency 53-Lead Hazard Usual Inspect Satisfactory(4) <br /> 08-Invalid 1 Unable To Verify 51 - Lead Hazard Work Plan Submitted(2) <br /> 09- Foodborne Illness 54- Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55- Lead Hazard Monitoring Schedule (6) <br /> 12-Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete (7) <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant W/Soil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> i, <br /> ii <br /> i <br /> 0104.rpi i' <br />