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n Complaint Investigation Form Report*5104 <br /> COMPLAINT ID: C00042541 Site Location: 678 N WILSON WAY Account ID: AR0004645 <br /> Receivedby: EE0000025 SEDRA Received Date: 11/10/2016 Pdnt Date: 11/10/201611:1343AM <br /> Assigned To.: EE0008999 HUYNH Assigned Date: 11/10/2016 <br /> Pmorem/Element Code 1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature ofcomplaint: <br /> COMPLAINANT ALLEGES THAT THEY WERE AT THE FACILITY ON 10/28/2016 AND PURCHASED A BAG OF KRUTZ PANCAKE MIX THAT WAS <br /> ON SALE.COMPLAINANT OPENED THE BAG ON 11/4/2016 AND FOUND WEEVILS IN THE PANCAKE MIX. <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 /> I-Intemet/Email S-Sheriffs Office <br /> ----------------- - - --------------------------- - <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002463-PAQ Inc.DBA Food-4-Less Owner: OW0001562-PAQ INC <br /> She Location 678N Wilson Way RPiDBA <br /> Stockton,CA 95205 RP Address 8014 LOWER SACRAMENTO RD STE I <br /> Gross Sheet FREMONT STOCKTON,CA 95210 <br /> Mailing Address: 17935 Murphy Parkway Billing Address 17935 MURPHY PARKWAY <br /> Lathrop,CA 95330 LATHROP,CA 95330 <br /> Home Phone :209-957.4917 <br /> Phone :209-066-2751 EXT: Work Phone :209-858-0101 EXT: 336 <br /> District 001-V I LLAPUDUA,CARLOS Location Code 01-STOCKTON <br /> APN 14129006 <br /> Date Abated vv-f( I— Inspector to <br /> --- - --------------------------------- - ----------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -Field Response-Violations Cited and Corrected 26-Alleged FBI-No Major Violations Identified <br /> 02-Office Response Only 29-Alleged FBI-Major 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-Reffened to Other Agency <br /> 08-Unable to Verity 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 /> ompaint Reviewed by Date Updated by: ate: p <br /> 5 t Oarpt <br />