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Complaint Investigation Form Report#: 5104 <br /> COMPLAIN ID: C00036012 Site Location: 877 E MARCH LN Account ID AR0004794 <br /> Receive by. EED000467 CARRUESCO Received Date: 2/12/2013 Print Date: 2/12/2013 1 1:17:46AM <br /> Assigned To. EE0003361 FLOHRSCHUTZ Assigned Date: 2/12/2013 <br /> Pro ram/Element Code:1600-FOOD PROGRAM <br /> Complainant: : Home Phone <br /> Address <br /> Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> 7 RESIDENTS AND 1 EMPLOYEE WITH SYMPTOMS OF VOMITING, NAUSEA,AND DIARRHEA. <br /> ***FAX TO ** <br /> Complaint Mode. A 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 /> 1-Internet!Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002666-RIO LAS PALMAS Owner: OW0002018-FIVE STAR RIO LAS PALMAS LLC <br /> Site Location 877 E MARCH LN RP/DBA RIO LAS PALMAS <br /> STOCKTON.CA 95207 RP Address 877 E MARC]I LN <br /> Cross Street MARCH STOCKTON,CA 95207 <br /> Mailing Address: 877 E MARCH LN Billing Address 877 E MARCH LN <br /> STOCKTON.CA 95207 STOCKTON,CA 95207 <br /> Home Phone :209-957-4711 <br /> Phone :209-957-4711 Work Phone <br /> District Location Code <br /> APN 10409011 <br /> Date Abated Inspector ID#.' �. <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br /> EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARDIUNSECU RED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104 rpt <br />