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Complaint Investigation Form Report#:5104 <br /> OMPLAINT 1[]: 000031536 Site Location: 4555 N PERSHING AVE STE 22 AccountiD: AR0004665 <br /> Received by., EE0001788 VAN FLEET Received Date: 2/4/2010 Print Date: 2/4/2010 &25:04AM I <br /> Assigned To: EE0003474 VEGA Assigned Date: 2/4/2010 1 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: :JEFF,STOCKTON FIRE DEPARTMENT Nome Phone : 209-607-9384 <br /> Address ; Work Phone :209-937-8030 <br /> E-Mail Address <br /> Nature of complaint., <br /> FIRE AT FACILITY. <br /> t <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax ! <br /> E-Cade Enforcement M-Mail l Correspondence O-Other EH Unit P-Phone <br /> --- — ------------ ------ <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002511-FATS GRILL&BAR Owner: OW0001916-MEHARG TNC <br /> Site Location 4555 N PERSHING AVE STE 22 <br /> RP/DBA FATS GRILL&BAR <br /> STOCKTON,CA 95207 RP Address 3626 CHATSWORTH CIR <br /> Cross Street STOCKTON,CA 95209 <br /> Mailing Address: 4555 N PERSHING STE##22 Billing Address 3626 CHATSWORTH CIR <br /> STOCKTON,CA 95207 STOCKTON,CA 95209 <br /> Nome Phone :209-403-0115 <br /> Phone :209473-3281 Work Phone :209-473-3281 <br /> District 002-RUHSTALLER,LARRY Location Code 01 -STOCKTON <br /> APAI 11017001 <br /> I <br /> Date Abated a S /p Inspector: 3 <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> I <br /> Complaint Status Code: <br /> I <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement Regired-See Program Record File <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> (9-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 51/pt <br />