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lY� Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00014335 Site Location: 8023 WESTLANE Account ID: AR0004856 <br /> Received by: EE0000099 Frost Received Date: 6/26/2000 <br /> Assigned To: EE0000321 OLIVEIRA /Assigned Date: 6/26/00 <br /> Proaram/Element Code: 185r-FOOD PROGRAM ���...N <br /> Complainant: CITIZEN-BARBARA BLAND Home Phone: 209-952-1605 <br /> Address: Work Phone: 209-478-3193 <br /> Nature of complaint: ? <br /> 6.25.00 PURCHASED WHOPPERS 11:30 A.M.,BARBARA AND CHILD(12 YR.OLD)BECAME ILL AT 2:00 P.M.. CHILD STARTED VOMITING, <br /> DIARRHEA. BARBARA WAS QUEASY, DIARRHEA. SON HAD STOMACH CRAMPS. <br /> Complaint Mode P Complaint Mode Codes A-Agency Referr B-Bd of Supervisors/Citj C-Count( E-Code Enforcem( <br /> M-Mail/Correspond( O-Other EH Unit P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0002725-BURGER KING OW0001512-WYMOND,GIL <br /> Site Location: 8023 WEST LN DBA: BURGER KING <br /> STOCKTON,CA 95210 RPAddress: PO BOX 380 <br /> Mailing Address: PO BOX 380 <br /> RIVERBANK,CA 95367 Billing Address: PO BOX 380 <br /> Phone: 1st: 209-952-6595 RIVERBANK,CA 95367 <br /> Phone: Hm: 209-869-4581 <br /> Wk: <br /> District: 003-SIMAS, EDWARD Location Code: 01 -STOCKTON <br /> APN: <br /> Date Abated., &12k1 ro <br /> Inspector: .t l—..•r` <br /> Send Referral to: <br /> Referral Letter Sent by., <br /> Referral Address: Date: <br /> Complaint Status Code: 1)( <br /> 01 -Field Abated 10-Substandard Property-See HOUSING ABATEMENT 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 50- Lead Hazard Evaluation Required(1) <br /> /06 3 EHD Permit Facility-See Linked Premise File 52- Lead Hazard Abatement in Progress(3) <br /> X97' Referred To Other Agency 53- Lead Hazard Visual Inspect Satisfactory (4) <br /> 08-Invalid/Unable To Verify 51 -Lead Hazard Work Plan Submitted(2) <br /> 09-Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55-Lead Hazard Monitoring Schedule (6) <br /> 12-Enforcement Case-Transferred To LIQUID WASTE File 56-Lead Hazard Abatement Complete (7) <br /> 13-Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant W/Soil Contamination <br /> 14-Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> 0104.rpt <br />