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Complaint Investigation Form Report#:5104 <br /> ' 3 <br /> COMPLAINT ID: 000022271 Site Location: 4555 N PERSHING AVE 16 Account ID: AR0004707 <br /> Received by: EE0000467 CARRUESCO Received Date: 2/23/2005 Print Date: 2/23/2005 11:05:46AM <br /> r <br /> Assigned To: EE0000467 CARRUESCO Assigned Date: 2/23/2005 <br /> t <br /> Prouram/Element Code:1600-FOOD PROGRAM <br /> Complainant:,. :STANISLAUS CO.C.D.TRUDI Name Phone <br /> Address s Work Phone O J ...S-6 <br /> 70 <br /> . e <br /> Nature of complaint. ' <br /> CALL FROM STANISLAUS C.D. DEATH OF AN ELDERLY MALE DUE:TO VIBRIO VULNIFICUS INFECTION. PURCHASED LIVE CRAB FROM <br /> ASIAN SUPERMARKET ON 02-12-05 IN THE MORNING AND BOILED AND ATE FOR DINNER THAT SAME NIGHT. INDIVIDUAL DIED 02-14-05. <br /> SS6e.�,nt <br /> Complaint ode: A l j Complaint Mode Codes A Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone <br /> -------------- _._..-------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002514-ASIAN SUPERMARKET Owner; OW0001919-UNG,ALICIA <br /> Site Location 4555 N PERSHING AVE 16 RP/DBA ASIAN SUPERMARKET <br /> STOCKTON,CA 95207 RP Address 8667 MARINERS DR#67 <br /> STOCKTON,CA 95219 <br /> Mailing Address: 4555 N PERSHING#16 Billing Address 8667 MARINERS DR 967 <br /> i <br /> STOCKTON,CA 95207 STOCKTON,CA 95219 <br /> Nome Phone :209-952-3508 <br /> Phone :209-957-3097 Work Phone :209-957-3097 <br /> r <br /> District 002-MARENCO,DARIO Location Code 01-STOCKTON �O <br /> APN 11017001 <br /> Date Abated i Inspector- <br /> ------------------------------------------------- <br /> nspector. <br /> ---------------------------------------.—.-_ _._—--.. — — <br /> Send Referral to Referral Letter Sent by <br /> ReferralAddress Date: <br /> 1, <br /> Complaint Status Code: Complaint History <br /> 1 i Attached But Not <br /> Circle appropriate Status.Code Scanned <br /> 01-RELDABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> 02-OFFICE ABATED 1 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT t ; 1$-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 /> k <br /> 06-EHD.PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE to VERIFY 28-FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS 'I 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANl1DARD PROPERTY-SEE HOUSING ABATEMENT FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE=Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 13-ENFORCEMENTCASE'-.-transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> + d' 1 <br /> ;f <br /> 5104_rpt <br />