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Complaint Investigation Form Report#: 5104 <br /> COMPLAIN ID: C00040976 Site Location: 3900 WEST LN Account ID AR0004613 <br /> Received by: EE0000028 ALI Received Date: 1/26/2016 Print Date: 1/26/2016 10:05:04AM <br /> Assigned To: EE0009488 WONG Assigned Date: 1/26/2016 <br /> Program/Element Code 71600-FOOD PROGRAM i <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: 4 <br /> ON 1/25/2016 AT APPROXIMATELY 4:30 PM THE COMPLAINANT SAW TWO COCKROACHES ON THE COUNTER WHILE WAITING FOR THEIR <br /> DINNER.COMPLAINANT CANCELED THEIR FOOD ORDER AND WALKED OUT. PLEASE CALL COM PLAI NANT,WITH FINDINGS. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Intemet l Email S-Sheriffs Office. I' <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002383-WEST LANE BOWL Owner: OW0001829-WEST LANE BOWL INC <br /> Site Location 3900 WEST LN RP/DBA WEST LANE BOWL <br /> STOCKTON,CA 95204 RP Address 3900 WEST LN ' <br /> . I <br /> Cross Street WEST STOCKTON,CA 95204 <br /> Mailing Address: 3900 N WEST LN Billing Address 3900 N WEST LN <br /> STOCKTON,CA 95204 STOCKTON,CA 95204 <br /> Nome Phone <br /> Phone :209-466-3317 EXT: Work Phone209-466-3317 EX I <br /> District 002-MILLER,KATHERINE Location Code i <br /> APN 11703020 <br /> Date Abated 01 Inspector 1D#: <br /> —————————— --y'----------- ----- ———— -------- <br /> Send Referral to Referral Lett ent by lI <br /> ti <br /> Referral Address Date: l:- <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> is <br /> ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED � WZQ OODBORNE ELL pr Violations Identified <br /> 02-OFFICE ABATED <br /> T <br /> BORNE ILLNESS-Major Violations Identified <br /> 50-LAssessment Performed-No AbItBtnentRegt+ired–� <br /> 52-LEAD Abatement Regired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATEb 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 MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED S U BSTANDARDIU NSEC U RED-See Housing File RS-Resolved-New Well Installed i <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> -t <br /> omp aint Reviewed by: ate: Updated by: ate: <br /> 5104.rp1 ' <br />