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„J� Complaint Investigation Form Report#:5104 <br /> i <br /> F <br />` COMP AINT ID: C00027246 Site Location: 678 N WILSON WAY Account ID: AR0004629 <br /> eceivedby. EE0000321 OLIVEIRA Received Date: 11/2/2007 Print Date: 11/5/2007 8:30:09AM <br /> Assigned To: EE0006213 PEDRAZA Assigned Date: 11/2/2007 ; <br /> Program/Plement Gode:1600-FOOD PROGRAM SCANNED I <br /> Complainant: : <br /> <br /> <br /> 4 <br /> Nature of complaint. <br /> (C)AND BOSS BOTH ATE CRUNCH CHICKEN TACOS ON 10/29/07 AT NOON. BOTH BECAME ILL WITH THE SYMPTOM OF EXTREME <br /> DIARRHEA. FOR THE((C), DIARRHEA STARTED AT 7 PM AND LASTED UNTIL MIDNIGHT. NO DOCTOR VISIT. <br /> —PLEASE CALL(C)BACK AFTER INSPECTION. <br /> Complaint Mods: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors i City Council C-Counter <br /> E-Cade Enforcement M-Mail f Correspondence O-Other EH Unit P-Phone <br /> ---- ----------- ——————————— <br /> ` FACILITY INFORMATION OWNER INFORMATION I <br /> r <br /> Facility:FA0002462-EL POLLO LOCO 43307 Owner: OW0001417-NOR-CAL CHICKEN <br /> Site Location 678 N WILSON WAY RP/DBA EL POLLO LOCO J <br /> STOCKTON,CA 95205 RP Address 3429 GAGOSIAN CT CT i <br /> MODESTO,CA 95356 <br /> Mailing Address: 4230 KIERNAN AVE STE#105 Billing Address 3429 GASGOSIAN CT <br /> MODESTO,CA 95356 MODESTO,CA 95356 <br /> i <br /> Home Phone ;209-545-2943 <br /> { Work Phone ;209-951-4761 <br /> Phone :209-942-2144 <br /> i. <br /> District 001 -GUTIERREZ,STEVE Location Code 01 -STOCKTON <br /> APN 14129014 <br /> :i <br /> Date AbatedInspectorlid � -7 (�n�1 <br /> — <br /> Send Referral to Referral Letter Sent byi I <br /> Referral Address Date: <br /> Complaint Status Code: :I <br /> B <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 16-LETTER SENT TO TENANT <br /> t 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY ^ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 08-UNABLE TO VERIFY 28- OODBORNE ILLNESS-Unconfirmed 1 No Major Violations <br /> 1 <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 /> Complaint History <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 31 -15 Day Letter Sent-Alleged Complaint Aged$t1t Not <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) Scanned I <br /> �J <br /> completed <br />