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Report#: 5104 <br /> Complaint Investigation Form <br /> COMPLAINT ID: C00023283 Site Location: 4555 N PERSHING AVE 16 <br /> Account 1D: AR0004707 <br /> Received by: EE0003474 VELA <br /> Received Date: 8/30/2005 Print Date: 8130!2005 3:44;40PM <br />` Assigned To: EE0000467 CARRUESCO Assigned Date: 8/30/2005 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: : CHRIS Home Phone .: 204-601-2938 <br /> Work Phone <br /> Address <br /> Nature of complaint: <br /> ORDERED FOOD TO GO ON 08/29/05 @ 2:30PM. ALL 4 PEOPLE GOT SICK,VOMITING, DIARRHEA,AND STOMACH CRAMPS. FOOD <br /> CONSISTED OF FRIED CHICKEN, SHORT RIBS WITH VEGETABLES, CRAB,AND MEAT STIR FRY WITH VEGETABLES. <br /> Complaint Mode. P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C Counter <br /> E-Code Enforcement M-Mail 1 Correspondence 'O-Other EH Unit P-Phone <br /> —--------------------------------------- <br /> FACILITY <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 /> STOCKTON,CA 95207 STOCKTON,CA 95219 <br /> Home Phone :209-952-3508 <br /> Phone :209-957-3097 Work Phone :209-957-3097 <br /> District 002-MARENCO,DARIO Location Code 01 -STOCKTON Complaint History <br /> APN 11017001 Attached But Not <br /> ScannedDate Abated 7— / -- O �— Inspector: 7 <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: �7Q <br /> Circle appropriate Status Code 1 <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred 10 ER FILE <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 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILL= <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD 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-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> 51 o4.rpt - <br />