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N,• 1 Complaint Investigation Form Report#: 5104 <br /> COMPLAUT ID: C00041345 Site Location: 678 N WILSON WAY Account/D., AR0014800 <br /> Receivedby: EE0000028 ALI Received Date: 4/13/2016 Print Date: 4/13/2016 3:08:36PM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 4/13/2016 <br /> Pmoram/Etement Code 1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature of complaint: <br /> TWO DEAD COCKROACHES IN THE BANQUET ROOM. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> 1-Intemet/Email S-Sherifrs Office <br /> _ —— — ———— —— — — — <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0007973-TOMMVS CAFE Owner: OW0010866-NGUYEN,TICH LUU <br /> Site Location 678 N WILSON WAY RPiDBA <br /> STOCKTON,CA 95205 RP Address 8850 MCCABE LAKES DR <br /> Cross Street STOCKTON,CA 95212 <br /> Mailing Address: 8850 MCCABE LAKES DR Billing Address 8850 MCCABE LAKES DR <br /> STOCKTON,CA 95212 STOCKTON,CA 95212 <br /> Home Phone ;209-951-0233 <br /> Phone :209-462-3000 EXT: Work Phone 209-462-3000 <br /> District 001-VILLAPUDUA,CARLOS Location Code <br /> APN 14129013 <br /> Date Abated lj M/110 Inspector ID#: <br /> ------------------ — —_— ----------------- - -- <br /> Send Referral to Referral Letter Sent b <br /> Referral Address 1 Date: <br /> Complaint Status Code:�D <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-Field Response-Violations Cited and Corrected 28-Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29.Alleged FBI-Ivor Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Refferred to Other Agency <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompamt Revewed by: . ate: Updated by: ate: <br /> 5104 rpt <br />