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Complaint Investigation Form Report#:5104 <br /> OMI�LAINT ID: 000020082 Site Location: 4555 N PERSHING AVE 16 AccountlD: ARao04707 <br /> Receivedby: EE0090753 MARTINEZ Received Date: 12/612003 Print Date: 12/8/2003 11:03:51AM <br /> Assigned To: EE0000321 OLIVEIRA Assigned Date: 12/8/2003 <br /> Program/Element Code 1619-RETAIL MKT>1000 SQ FT(=1>2 DEPTS) <br /> Complainant: : RANDY Home Phone <br /> Address Work Phone :209-404-32/8 <br /> I <br /> Nature ofcomplaint. <br /> ON 12102(C)ATE AT DELI @ 11:30AM BUFFET RICE&CHICKEN,ABOUT AN HOUR LATER STARTED VOMITING VERY BADLY.(C)THINKS <br /> THEY LEAVE FOOD OUT ALL FOOD OVER NIGHT. <br /> (C)IS 35 YR OLD MAN. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors t City Council C-Counter <br /> L I E-Code Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone <br /> v <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA00025.14-ASIAN SUPERMARKET Owner: OW0001919-UNG,ALICIA <br /> Site Location 4555 N PERSHING AVE 16 RPIDBA ASIAN SUPERMARKET <br /> STOCKTON,CA 95207 RPAddress 8667 MARINERS DR#f67 <br /> STOCKTON,CA 95219 <br /> Mailing Address: 4555 N PERSHING#16 Silting Address 8667 MARINERS DR#67 <br /> STOCKTON,CA 95207 STOCKTON,CA 95219 <br /> Nome Phone ;209-952-3508 <br /> Phone 209-957-3097 Work Phone :209-957-3097 <br /> District 002-MARENCO,DARIO Location Code 01 -STOCKTON <br /> APIV 11017001 <br /> i <br /> Date Abated -- ^ t d Inspector: (/�� C-),5-Z-/ � <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> I <br /> i <br /> i <br /> 1 <br /> Complaint Status Code: � <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> ( <br /> 02-OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT 16-LETTER SENT TO TENANT <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 28 FOODBORNE ILLNESS•Unconfirmed <br /> 08-UNABLE TO VERIFY 29-FOODBORNE ILLNESS-Confirmed <br /> 09-FOODBORNE ILLNESS 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 51 -LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 54-LEAD HAZ DUST EVALUATION SATISFACTORY(5) <br /> -Vj '1 <br /> CO C°� <br /> 5104.rpt <br />