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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00039775111 <br /> ite Location: 4555 N PERSHING AVE STE 18C Account ID. AR0004994 <br /> Received by: EE0000467 CARRUESCO Received Date: 5/30/2015 Print Date: 6/1/2015 2:06:18PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 5/30/2015 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: JOSEFINA LOPEZ Home Phone <br /> Address Work Phone . <br /> -Mail Address a, <br /> Nature of complaint: <br /> COMPLAINANT WENT TO HAVE MENUDO ON 5/30/2015 AND WITNESSED ONE OF THE OLDER LADIES FROM THE KITCHEN WENT TO THE <br /> RESTROOM AND DID NOT WASH HER HANDS.WHEN THE LADY RETURNED TO THE KITCHEN,COMPLAINANT HEARD A MAN WHO WAS <br /> ALSO WORKING IN THE KITCHEN TELL THE WOMAN"DON'T BE DIRTY WASH YOUR HANDS,YOU NEVER DO".THE COMPLAINANT THEN <br /> HEARD THE WOMAN REPLY"IT'S THE FLAVOR OF MY HOMEMADE TORTILLAS".COMPLAINANT ALSO SAW CHIP TRAYS BEING DUMPED <br /> BACK INTO THE CHIP WARMER AND BEING RE-SERVED.THERE ARE ALSO FAMILY MEMBERS COMING INTO RESTAURANT AND GOING <br /> BEHIND THE COUNTERS AND TASTING THE FOOD OFF THE GRILL AND FROM THE SERVING AND PREPPING AREAS. <br /> Complaint Mode I Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet l Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0004641-CAROLINA/LOS TRES PRIMOS Owner: OW0015183-ANGULO,SERGIO&VALLE,JUAN <br /> Site Location 4555 N PERSHING AVE STE 18C RP/DBA CAROLINAJLOS TRES PRIMOS <br /> STOCKTON,CA 95207 RP Address 2406 HANNA BAY CT <br /> Cross Street STOCKTON,CA 95210 <br /> Mailing Address: 4555 N PERSHING AVE STE 18C Billing Address 2406 HANNA BAY CT <br /> STOCKTON,CA 95207 STOCKTON,CA 95210 <br /> Home Phone :209-951-3972 <br /> Phone :209-474-0386 Work Phone :209-474-0386 <br /> District 002-MILLER-KATHERINE Location Code 01-STOCKTON <br /> APN 11017001 11_ <br /> Date Abated (P— 5 —` 5 Inspector ID#: to (�r 5 C_ �� Z <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:O(p <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06 EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> omp aintReviewed y. ate: p ate y: ate' <br /> 5104 rpt <br />