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Y Complaint Investigation Form Report# 5104 <br /> COMI7CAINT ID: C00034165 Site Location: 10742 TRINITY PKWY STE C AccountlD: AR0027671 <br /> Receivadby: EE0090753 MARTINEZ Received Date: 10/3/2011 Pnnt Date 10/3/2011 4:01:54PM <br /> Assigned To: EE0001699 YOAKUM Assigned Date: 10/3/2011 <br /> Pmaram/Element Code 1600-FOOD PROGRAM <br /> Complainant: :TIM RUNION STOCKTON FIRE Home Phone <br /> Address <br /> Work Phone <br /> E-Mail Address <br /> Nature of complaint., <br /> (C)STATES THE ANSEL SYSTEM WAS DISCHARGED AT THIS FACILITY.NO FIRE. <br /> Complaint Mode: P Complaint Motle Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet/Email S-Shenffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0015905-WING STOP Owner. OW0012827-RYAN,MICHAEL <br /> Site Location 10742 TRINITY PKWY STE C RP/DBA WING STOP <br /> STOCKTON,CA 95219 RP Address 10506 CLARKS FORK CIR <br /> Cross Street STOCKTON,CA 95219-7181 <br /> Mailing Address: 10742 TRINITY PKWY STE C Billing Address 10506 CLARKS FORK CIR <br /> STOCKTON,CA 95219 STOCKTON,CA 95219-7181 <br /> Home Phone :209-351-5983 EXT: CELL <br /> Phone :209-474-3238 Work Phone <br /> District 004-VOGEL,KEN Location Code 01 -STOCKTON <br /> APN 06602019 <br /> Date Abated ( 61'1y��l Inspector ID#: ( � <br /> \—\--——— ——— — — --— - -- - - - <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code{�� 8 <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 03-NAI SENT 52-LEAD Abatement RegiredSee Program Record File <br /> 04-NOTICE TO ABATE ISSUED 97-Disaster Planning and Response <br /> 5-DA-ENFORCEMENT ACTION INITIATED 99-UNSPECIFIED-Old Complaint-No Original Found <br /> OB EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> -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 /> /N.rpt <br />