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J, <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C 0028137 Site Location: 4555 N PERSHING AVE STE 9 Account ID. AR0004634 <br /> l <br /> Received by: E 003474 VEGA Received Date: 411 012 0 0 8 Print Date: 4/23/2008 4:15A9PM <br /> Assigned To: EE0003474 VEGA {� �) Assigned Date: 4/23/2008 ; <br /> Program/Element Code:1600-FOOD PROGRAM i <br /> Complainant: :SANDRA Home Phone 209-953-1824 <br /> Address Work Phone " <br /> 'I <br /> I <br /> Nature of com taint: <br /> FOUR PEOPLE BECAME ILL(FATHER,MOTHER,AND TWO DAUGHTERS). ALL FOUR CONSUMED RICE, BEEF MIXED WITH VEGETABLES, <br /> AND SEAFOOD. ABOUT FOUR HOURS LATER, FATHER BECAME ILL WITH DIARRHEA AND ABDOMINAL PAIN. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> i — <br /> FACILITY INFORMATION OWNER INFORMATION j <br /> Facility:FA0002509-MEKONG HARBOR CHINESE CUISINE Owner: OW0001914-SAM,SOFIA <br /> Site LOcaflGn 4555 N PERSHING AVE STE 9 RPIDBA MEKONG HARBOR CHINESE CUISINE <br /> STOCKTON,CA 95207 RP Address 417 SULLIVAN CT <br /> MOUNTAIN HOUSE,CA 95391 <br /> Mailing Address.• 4555 N PERSHING AVE STE#9 Billing Address 417 SULLIVAN CT <br /> STOCKTON,CA 95207 MOUNTAIN HOUSE,CA 95391 <br /> Nome Phone :209-833-8283 <br /> Phone :209-474-1188 Work Phone :209-474-1188 <br /> District 002-RUHSTALLER,LARRY Location Code 01 -STOCKTON <br /> APN 11017001 <br /> Date Abated Inspector. <br /> -- ----- --- <br /> ----- ———— <br /> — <br /> Send Referral to Re rral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to 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 15-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> V <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed I No Major Violations <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint <br /> 1 i-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint Complaint History <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) Attached But Not <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED{2} Scanned <br /> Il <br /> 5104 rpt <br /> R <br />