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1 <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00029658 Site Location: 4555 N PERSHING AVE Account ID. AR0004636 <br /> Received by. EE0090753 MARTINEZ Received Date: 1/12/2009 Print Date: 1/12/2009 4:43:35PM <br /> Assigned To: EE0003474 VEGA Assigned Date: 1/1212009 <br /> Proaram/Element_Code:1600-FOOD PROGRAM <br /> Complainant: :SANDRA Nome Phone 209-609-6357 <br /> Address Work Phone <br /> Nature of Complaint.- <br /> ON <br /> om laint.ON 1110109,(C)&FAMILY WENT TO FACILITY. ALL SIX BECAME ILL WITH STOMACH CRAMPS AND DIARRHEA FROM EATING THE RANCH <br /> DRESSING,THE ONLY THING IN COMMON THAT ALL EAT. AGES OF(C)'S FAMILY: HUSBAND-48 YRS OLD;SON-23 YRS OLD; <br /> DAUGHTER-IN-LAW -21 YRS OLD. --'(C) REQUESTS A CALL BACK AFTER INSPECTION. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002529-JOHN'S INCREDIBLE PIZZA CO Owner: OW0011162-PARLET,JOHN <br /> Site Location 4555 N PERSHING AVE RP/DBA JOHNS INCREDIBLE PIZZA CO <br /> STOCKTON,CA 95207 RPAddress 1 ORCHARD STE 195 <br /> Cross Street LAKE FOREST,CA 92630-8314 <br /> Mailing Address: 1 ORCHARD STE 195 Billing Address I ORCHARD STE 195 <br /> LAKE FOREST,CA 92630-8314 LAKE FOREST,CA 92630-8314 <br /> Nome Phone ;805-748-2694 <br /> Phone :209-952-0537 Work Phone :805-595-3333 <br /> District 002-RUHSTALLER,LARRY Location Code 01 -STOCKTON <br /> APN 11017001 <br /> Date Abated / — 1-5'—Or <br /> S— Inspector. -3q;x <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code. 4t <br /> Circle appropriate Status Cadet/ <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 /> 0 ENFORCEMENT ACTION INITIATED 18-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 /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed 1 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 Complaint History <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint Attached But Not <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) Scanned <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 5104 rpi <br />