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Complaint Investigation Form Report#:5104 <br /> COMPLAI T ID: C00035344 Site Location: 678 N WILSON WAY Account ID: AR0004629 <br /> Recei d by: EE0090753 MARTINEZ Received Date: 8/16/2012 <br /> Print Date: 8/16/2012 1:39:26PM <br /> Assigned To: EE0006213 PEDRAZA <br /> Assigned Date: 8116!2012 <br /> Pro ram/El men Coda:1600-FOOD PROGRAM <br /> Complainant- : <br /> <br /> <br /> <br /> Nature of complaint: <br /> THERE WAS WATER WITH BLACK SUBSTANCE DRIPPING FROM A VENT OVER THE PREP AREA&COUNTER AREA BETWEEN WHERE THE <br /> FOOD IS FINISHED BEING PREPPED&THEN BEING SERVED TO CUSTOMERS.THE MANAGER WAS ON A LADDER WIPING IT WITH A <br /> GREEN RAG&THE RAG BECAME WET&VERY DIRTY WITH A THICK BLACK OILY SUBSTANCE.SHE STUFFED THE RAG IN THE CORNER OF <br /> THE VENT WHERE IT WAS DRIPPING&GOT DOWN OFF THE LADDER,THE LIGHT COVER NEXT TO THE VENT HAD A PUDDLE OF WATER <br /> GATHERING 1N IT. <br /> Complaint Mode: O Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet 1 Email S-Sheriffs Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0002462-EL POLLO LOCO#3307 Owner: OW0001417-NOR-CAL CHICKEN <br /> Site Location 678 N WILSON WAY RP/DBA EL POLLO LOCO <br /> STOCKTON,CA 95205 RPAddress 1202 TULLY RD STE C <br /> Cross Street WILSON MODESTO,CA 95350 <br /> Mailing Address: 1202 TULLY RD STE C Billing Address 1202 TULLY RD STE C <br /> MODESTO,CA 95350 MODESTO,CA 95350 <br /> Home Phone :209-545-2943 <br /> Phone :209-942-2144 Work Phone :209.951-4761 <br /> District Location Code <br /> APN 14129003 <br /> Date AbatedJoh Inspector ID#.- <br /> Send <br /> :Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: (J CJ <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Ctosed <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpi <br />