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• 1,rgr� ii�z' Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00046004 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Receivedby: EE0000467 CARRUESCO Received Date: 3/19/2018 Print Date. 3/20/2018 9:42:06AM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 3/20/2018 <br /> Pn2gram1Element Code:1600-FOOD PROGRAM <br /> Complainant: :ERNEST GARCIA-CITY OF STOCKTON MUNICIPAL UTILITIES DEP Home Phone <br /> Address : Work Phone <br /> -Mail Address <br /> Nature ofcomplaint: <br /> COMPLAINANT ALLEGES DURING THEIR FATS,OIL AND GREASE INSPECTION THEY NOTICED A METAL TRAY ON THE FLOOR COLLECTING <br /> USED COOKING OIL THAT WAS LEAKING UNDERNEATH TWO FRYERS.ALSO NOTICED AN EMPLOYEE SCOOPING THE USED COOKING OIL <br /> FROM THE METAL TRAY UNDERNEATH THE FRYERS BACK INTO THE FRYERS BEING USED TO COOK THE CHICKEN. <br /> Complaint Mode: A 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 /> 1-Intemet/Email S-Sherifrs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002725-CHURCHS CHICKEN#5773 Owner: OW0010559-H&R FOODS INC <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 :209-475-1547 Work Phone :209-475-1547 EXT: BUSINESS <br /> District 003-BESTOLARIDES,STEVE Location Code 01-STOCKTON <br /> APN 08818007 <br /> Date Abated _ " IV Inspector/D#: K/LAV-0- <br /> —_- --4----------------------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: y� <br /> (_Ci rcle appropriate Status Code <br /> 01 Field Response-Violations Cited and Comected 50-LEAD Assessment Performed-No Abatement Required <br /> Office Response Only 52-LEAD Abatement Regired-See Program Record File <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> 1 <br /> ompamt Reviewed Date: pate <br /> �b ( by: ate: 111,911F I <br /> 5104.rpt IF I <br />