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A.4, <br /> Complaint Investigation Form Report#:5104 <br /> I <br /> COMPLAINT ID: C00041717 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Peceivedby: EE0000020 MEUANGKHOTH Received Date: 6/17/2016 Print Date: 6/20/2016 8:38:56AM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 6/20/2016 <br /> Procranr/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> -Mail Address <br /> Nature ofcomplaint: <br /> COMPLAINANT WENT TO FACILITY WITH WIFE ON 6/16/2016 AROUND 4:00 PM-5:00 PM.RESTROOM KEY LOST,SO RESTROOM NOT <br /> AVAILABLE FOR WOMEN.DRIVE-THRU AREA BEHIND THE COUNTER HAS A BUSTED PIPE LEAK,WATER IS EVERYWHERE. NOTHING IS UP <br /> TO DATE IN THE FACILITY. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> -------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002725-CHURCHS CHICKEN#5773 Owner: OW 0010559-H&R FOODS fNC <br /> Site Location 8023 WEST LN RP/DBA CHURCH'S CHICKEN#5773 <br /> STOCKTON,CA 95210 RP Address 6248 PACIFIC AVE <br /> Cross Street WEST LANE STOCKTON,CA 95207 <br /> Mailing Address: 6248 PACIFIC AVE Billing Address 6248 PACIFIC AVE <br /> STOCKTON,CA 95207 STOCKTON,CA 95207 <br /> Home Phone :661-703-7298 EXT: CELL <br /> Phone :209475-1547 Work Phone 209-475-1547 EXT: BUSINESS <br /> District 003-BESTOLARIDES,STEVE Location Code <br /> APN 08818007 <br /> Date Abated U \"1 V Inspector ID#: 9-4 64lr� <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-Field Response-Violations Cited and Corrected 28-Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Re#erred to Other Agency <br /> 08 Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 0 <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE if <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompaint Reviewed by: Data: <br /> Updated y: ate: <br /> 5104 P, <br />