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31 <br /> v� � #: <br /> Complaint Investigation Form Report 5104 <br /> ill <br /> COMPLAINT ID: C00015725 Site Location: 678 N WILSON WY 38 Account 1D: AR0014622 <br /> Received by: EE0000794 MATHEW Received Date: 3/30/2001 <br /> Assigned To: EE0000321 OLIVEIRA Assigned Date: 3130101 <br /> ProramlEtement Code: 1614-FOOD EST>1001 SQ FT WIO SEATING <br /> Complainant: <br /> <br /> <br /> Nature of complaint. <br /> 5 YEAR OLD CHILD ATE SALAMI&CHEESE PIZZA PURCHASED FROM STORED AND BAKED AT HOME ON 03-10-01. HE BECAME ILL ON <br /> 03-11-01. DIAGNOSED WITH SHIGELLA ON 03-28-01. I, <br /> TWO OTHER CHILDREN ATE SAME PIZZA MOTHER SAID SHE DID NOT KNOW IF THEY BECAME ILL. <br /> ii <br /> Complaint Mode P Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council E-Code Enforcement <br /> M-Mal[/Correspondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0007931 -PAPA MURPHYS TAKE N BAKE PIZZA Owner: OW0001169-4 U SMC INC 1, <br /> RPIDBA: PAPA MURPHYS TAKE N BAKE PIZZA <br /> Site Location: 678 N WILSON WY 38 <br /> RP Address: 489 GRINDSTONE ST <br /> STOCKTON,CA 95205 <br /> WOODBRIDGE,CA 95258 <br /> Mailing Address: 489 GRINDSTONE ST <br /> WOODBRIDGE,CA 95258 Billing Address:: 489 GRINDSTONE ST <br /> STOCKTON,CA 95258 <br /> Phone: 1st: 209-943-7272 Phone: Hm: 209-333-7889 ; <br /> Wk: 209-369-5765 <br /> District Location Code 01 -STOCKTON <br /> i <br /> APN <br /> Date Abated <br /> Inspector 3t37 <br /> 3 <br /> Send Referral to: <br /> Referral Address: i <br /> i <br /> ii <br /> Referral Letter Sent by: <br /> Date: <br /> 3 <br /> Complaint Status Code: <br /> 01 - Field Abated 10-Substandard Property-See HOUSING ABATEMENT 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 I <br /> 05-Enforcement Action Initiated 50-Lead Hazard Evaluation Required(1) <br /> 05-EHD Permit Facility-See Linked Premise File 52-Lead Hazard Abatement in Progress(3) <br /> 07-Referred To Other Agency 53-Lead Hazard Visual Inspect Satisfactory(4) <br /> Invalid/Unable To Verify 51 -Lead Hazard Work Plan Submitted(2) <br /> 09 Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> - <br /> Multiple Complaints-See Active Case# 55- Lead Hazard Monitoring Schedule (6) <br /> 12- Enforcement Case-Transferred To LIQUID WASTE File 56- Lead Hazard Abatement Complete (7) <br /> 13- Enforcement Case-Transferred To SOLID WASTE File 57- Lead Hazard Property Vacant W/Soil Contamination <br /> 14- Enforcement Case-Transferred To ER File 58- Lead Hazard Case-See Active File For This Site <br /> 1 <br /> 0104.rpt ii <br />