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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000043539 Site Location: 678 N WILSON WAY Account/D: AR0014800 <br /> Receivedby: EE0000012 MARTORELLA Received Date: 5/25/2017 PrintDate: 5/26/2017 9:55:31AM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 5/26/2017 <br /> Prooram/Element Cade:1600-FOOD PROGRAM <br /> Complainant : <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT WAS AT FACILITY THE MORNING OF 05-25-2017.SAW A LIVE COCKROACH IN THE BATHROOM AND ABOUT FOUR MORE IN <br /> THE DINING AREA.DID NOT NOTIFY STAFF. <br /> Complaint Mode: I 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-Internet/Email S-Sheriffs Office <br /> --- --------------- ------------ <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0007973-TOMMYS CAFE Owner: OW0010866-NGUYEN,TICH LUU <br /> Site Location 678 N WILSON WAY RP/DBA <br /> STOCKTON,CA 95205 RPAddress 8850 MCCAHE 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 01-STOCKTON <br /> APN 14129013 <br /> Date Abated tpo/ Inspector ID#., <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 0(b <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-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Regired-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-NewWell Installed <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompaint Hevieved by: � ate: Davy <br /> 5104.rp1 <br />