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Complaint Investigation Form <br /> 10 Report#; 5104 <br /> COMPLAINT ID: 00035820 Site Location: 678 N WILSON WAY AccountlD. AR0014800 <br /> Receivedby: EE0000467 CARRUESCO Received Date: 12/24/2012 <br /> Assigned To: EE0006213 PEDRAZA Print Date: <br /> Assigned Date: 12/24/2012 1/3/2013 11:51:53AM <br /> Program/Element Code-1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> <br /> <br /> Nature ofcomplaint: <br /> CUSTOMER ATE ON DEC 19 AND 20TH.ATE 2 BEEF BURRITOS&2 REGULAR TACOS ON 12119.ON 12120 ATE 2 BEAN&CHEESE BURRITOS <br /> AND 1 TACO&CHEESE QUESADILLA. BEGAN SYMPTOMS OF VOMITING, DIARRHEA, FEVER,WEAKNESS 12120 IN THE PM.HUSBAND GOT <br /> SICK TOO <br /> Complaint Mode: P Complaint Mode Godes A-Agency Referral B-Bd of Supervisors l City Council <br /> C-Counter F-Fax <br /> E-Code Enforcement M-Mail l Correspondence O-Other EH Unit P-Phone <br /> I-Internet!Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0007973-DEL TACO Owner: OW0006592-NOR-CAL FOODS,INC <br /> Site Location 678 N WILSON WAY RP/DBA DEL TACO <br /> STOCKTON,CA 95205 RP Address 3421 TULLY RD STE G-I <br /> Cross Street MODESTO,CA 95350 <br /> Mailing Address: 3421 TULLY RD STE G-1 Billing Address 3421 TULLY RD STE Cil <br /> MODESTO,CA 95350 MODESTO,CA 95350 <br /> Nome Phone :209-605-2589 <br /> Phone :209-521-9201 Work Phone :209-521-9201 <br /> District : Location Code <br /> APN <br /> Date Abated Lt Inspector ID#.• <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: � <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 26-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 Closed <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104rpt <br />