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044Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00042282 Site Location: 2425 W KETTLEMAN LN Accountia AR0020965 <br /> Receivedby: EE0000025 SEDRA Received Date: 9/22/2016 Print Date: 9/22/2016 94641AM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 9/22/2016 <br /> Program/Element Code,1600-FOOD PROGRAM <br /> Complainant: : MOHAMMAD RASOOL Home Phone 209-570-3741 <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES THAT ON 9/21/2016 AT APPROXIMATELY 8:19 PM THEY WENT THROUGH THE DRIVE THROUGH AND ORDERED <br /> TWO CHICKEN SANDWICHES.COMPLAINANT STATED THAT ONE OF THE CHICKEN SANDWICHES HAD A LIVE WORM BETWEEN THE <br /> LETTUCE AND THE CHICKEN PATTY.PLEASE CALL COMPLAINANT WITH FINDINGS. <br /> Complaint Mode: P Complaint Motle Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Coda Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> l4ntemet/Email S-Sheriffs Office <br /> ----------------- --------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0012662-JACK IN THE BOX#4301 Owner: OW0000819-Anil Yadaz <br /> Site Location 2425 W Kettlerm n Ln RP/DBA <br /> Lodi,CA 95242 RP Addmss <br /> <br /> <br /> <br /> <br /> <br /> District 004-W INN,CHARLES Location Code 02-LODI <br /> APN 02741008 <br /> Date Abated q I' v I I I Inspector ID#: <br /> Send Retemal to Referral Letter Sent by <br /> Re/emai Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-Field Response-Violations Cited and Corrected 28-Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Refferred to Other Agency <br /> 06 Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> mplaint evieeyalepate Qiva a <br /> 5104 rpt '. <br />