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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00024176 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Received by: EE0090753 MARTINEZ Received Date: 3/15/2006 /� PrintDate: 3/16/2006 8:42:17AM <br /> Assigned To: EE0003474 VEGA Assigned Date: 3115/2006 SCANNED <br /> Pro ram/Element Code:1600-FOOD PROGRAM F <br /> Complainant: Complainant Not Specified Home Phone <br /> Address Work Phone <br /> Nature of complaint: <br /> F5_SOAP OR SOAP DISPENSERS IN WOMEN'S RESTROOM. <br /> Complaint Mode: P ComplaintMode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone <br /> -- —=--------------------- -------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002725-CHURCH'S CHICKEN Owner: OW0010559-CENTRAL VALLEY QSR <br /> Site Location 8023 WEST LN RP/DBA CHURCH'S CHICKEN <br /> STOCKTON,CA 95210 RPAddress 7230 SOUTHLAND PARK DR <br /> SACRAMENTO,CA 95831 <br /> Mailing Address: 8023 WEST LANE Billing Address 7230 SOUTHLAND PARK DR <br /> STOCKTON,CA 95210 SACRAMENTO,CA 95831 ; <br /> Home Phone :209-473-8184 <br /> Phone :209-475-1547 Work Phone :209-475-1547 <br /> District Location Code 01 -STOCKTON <br /> APN <br /> Date Abated Inspector. 3r/7i1 <br /> ------------------------------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: ,qr <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER 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 /> 05-ENFORCEMENT ACTION INITIATED 1 B-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> -EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UtC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 26-FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 51 -LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> Complaint History <br /> Attached But Not <br /> CompletedScanned <br /> 5104.rp1 � <br />