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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: 000033514 Site Location: 678 N WILSON WAY STE 1 Account ID: AR0014696 <br /> Received by: F-E0009058 LOWE Received Date: 4/29/2011 Print Date: 4/29/2011 3:55:01PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 4/29/2011 <br /> Program/Element Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint.- <br /> FIRE <br /> om laint.FIRE AT FACILITY. <br /> i <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors!City Council C-Counter F-Fax <br /> I <br /> E-Code Enforcement M-Mail!Correspondence O-Other EH Unit P-Phone <br /> I-Intemet I Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002465-SUBWAY SANDWICH SHOP#5967 Owner: OW0003612-TIWANA,AMRITPAL <br /> Site Location 679 N WILSON WAY STE 1 RP/DBA SUBWAY <br /> STOCKTON,CA 95205 RP Address 5500 QUASHNICK RD <br /> Cross Street WILSON STOCKTON,CA 95212 ; <br /> Mailing Address: 5500 QUASHNICK RD Billing Address 5500 QUASHNICK RD ]J <br /> STOCKTON,CA 95212 STOCKTON,CA 95212 <br /> Nome Phone <br /> Phone ;209-466-2433 Work Phone . <br /> District 001-VILLAPUDUA Location Code 01 -STOCKTON <br /> APN <br /> Date Abated L-I r. <br /> —Z� Inspecto <br /> Send Referral to [[ Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: Q <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement Reqired-See Program Record File <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Otd Complaint-No Original Found <br /> 08 EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 00-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARDlUNSECURE D-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29.-FOODBORNE ILLNESS-Major Violations Identified <br /> s/1_P1 <br />