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y x Complaint Investigation Form Report M.5104 <br /> Al , <br /> COMPLAINT ID: 00028102 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Received by: E 0009249 WOODWARD Received Date., 4/17/2008 Print Date: 4/17/2008 4:41:20PM <br /> Assigned To: EE0006213 PEDRAZA Assigned Date: 4/17/2008 SCANNED <br /> ProQram/Efement Code:1600-FOOD PROGRAM <br /> Complainant: ;ANGIE LEAL Nome Phone : 209-373-3393 <br /> Address Work Phone ; <br /> Nature of complaint., <br /> ON 4111108,(C)PURCHASED A MEAL. WHEN SHE STARTED EATING HER MEAL,SHE NOTICED ROACHES COMING OUT OF THE BAG. SHE <br /> TOOK FOOD BACK TO FACILITY AND SHOWED THE MANAGER. THE MANAGER GAVE HER THE OWNER'S PHONE NUMBER. (C)SPOKE TO <br /> OWNER,WHO TOLD HER THERE WAS NOTHING THEY COULD DO. (C)STATED SHE IS A"GERM-PHOBIC"AND THE FOOD MADE HER ILL. <br /> Complaint Mode: P Complaint Made Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> FACILITY INFORMATION F 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 9 52 10 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 :209475-1547 <br /> District : Location Code 01 -STOCKTON <br /> APN n+� <br /> Date Abated Inspector. <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <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 1a-LETTER SENT TO TENANT <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 160 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 UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed i No Major Violations <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31-15 Day Letter Sent-Alleged Complaint <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> r <br /> 5104.rpt <br />