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givi Complaint Investigation Form Report#: 5104 <br /> CbMPLAMT ID: C00041711 Site Location: 8023 WEST LN Account 1D. AR0004856 <br /> Received by: EE0000025 SEDRA Received Date: 6/16/2016 PrintDate: 6/16/201610:10:31AM <br /> Assigned ToEE0001084 RAMIREZ Assigned Date: 6/16/2016 <br /> ProoramiElement Code 1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> -Mail Address <br /> Nature ofcomplaint: <br /> COMPLAINANT WAS AT FACILITY ON 6/15/2016 ATAPPROXIMATELY 5:00 PM AND NOTICED THAT THE EMPLOYEES BEHIND THE COUNTER <br /> IN THE RESTAURANT HAD WET SHOES,AND THE BOTTOM OF THEIR PANTS WERE ALSO WET DUE TO THEM STANDING IN WATER.THE <br /> FLOOR WAS FLOODED. <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-Intemet/Email S-Sheriff's Office <br /> ----------------------------------------------- --- <br /> PROPERTY <br /> ------------------- _-- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002725-CHURCHS CHICKEN#5773 Owner: OW0010559-H&R FOODS MC <br /> Site Location 8023 WEST LN RP/DBA CHURCH'S CHICKEN#5773 <br /> STOCKTON,CA 95210 RP Address 6248 PACIFIC AVE <br /> Cross Street HAMMER LN STOCKTON,CA 95207 <br /> Mailing Address: 6248 PACIFIC AVE Billing Adtlress 6248 PACIFIC AVE <br /> STOCKTON,CA 95207 STOCKTON,CA 95207 <br /> Home Phone :661-703-7298 EXT: CELL <br /> Phone :209.475-1547 Work Phone :209-475-1547 EXT: BUSINESS <br /> District 003-BESTOLARIDES,STEVE Location Code 01-STOCKTON <br /> APN 08818007 <br /> c <br /> Date Abated \J I'L Z7 ( IV Inspector ID#: <br /> ------------------------------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:_ <br /> Circle appropriate Status Code <br /> �1 <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> QField 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 /> Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> -Refferred to Other Agency <br /> 08-Unable to Verity Alleged Complaint MN-EHD Monitoring Status <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# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompamt Reviewed by: ate: Updated by: <br /> 5104 rct <br />