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� v Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000027426 Site Location: 678 N WILSON WAY <br /> Account ID: AR0004645 <br /> Received by: EE0007541 FIELD <br /> Received Date: 1213/2007 Print Date:12/14/2007 3:50:04PM <br /> Assigned To: EE0006213 PEORAZA Assigned Date: 12/1412007 <br /> Proarem/Element Code:1600-FOOD PROGRAM <br /> <br /> <br /> ; <br /> Address <br /> Nature of comPlaint: <br /> AT 9:33 AM ON 12!3!07,(C)PURCHASED GROUND BEEF.SUPER-LEAN HAMBURGER MEAT. WHEN (C)WENT TO USE THE MEAT,'SHE <br /> FOUND BLACK ITEMS MIXED INTO THE MEAT.(C)BELIEVES THE BLACK ITEMS ARE GROUND UP PLASTIC. STORE WAS NOT CONTACTED. <br /> ***(C)REQUESTS CALL BACK FROM INSPECTOR: <br /> A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> Complaint Mode: P Complaint Mode Codes 's <br /> — — —"— — _ __ E_ _ <br /> Code Enforcement M_Masl!Correspondence O Other EH Unit P Phone .; <br /> _ _—, <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002463-FOOD 4 LESS* Owner: OW0001562-PAQ INC <br /> RP/DBA <br /> Site Location 678 N WILSON WAY <br /> + STOCKTON,CA 95205 RP Address 8014 LOWER SACRAMENTO RD STE I <br /> STOCKTON,CA 95210 <br /> Mailing Address: 17935 MURPHY PARKWAY Billing Address 17935 MURPHY PARKWAY <br /> LATHAOP,CA 95330 LATHROP,CA 95330 <br /> Nome Phone :209-957-4917 <br /> Phone :209-957-4917 Work Phone 739-85K-0101I <br /> District Location Code <br /> APN , <br /> Date Abated 1 7 Q Inspector. —— <br /> -------- <br /> Send Referral to Referral Letter Sent by ; <br /> Referral Address Date: j <br /> Complaint Status Code: ? <br /> �I <br /> Circle appropriate Status Code $ <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> D2 OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 16-LETTER SENT TO TENANT I <br /> 03-NAI SENT <br /> 17-15 DAY LETTER SENT <br /> 04-NOTICE TO ABATE ISSUED <br /> I <br /> OS-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> �-EHO PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE# <br /> 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY ,I <br /> 07-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed i No Major Violations08 j <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Major Violations Identified i <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 30-15 Day Letter Sent-Confirmed Complaint <br /> 31-15 Day Letter Sent-Alleged Complaint Complaint History <br /> 11-Multiple Complaints-SEE ACTIVE CASE# .Attached But 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 <br /> 51-LEAD HAZ WORK PLAN SUBMITTED(2) Scanned <br /> I <br /> � I <br /> 5104.rpt <br />