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o(l✓� Complaint Investigation Form Report* 5104 <br /> COMPLAINT ID: C00048805 Site Location: 4555 PERSHING AVE Account ID: AR0004994 <br /> Received by: EE0000467 CARRUESCO Received Date: 2/7/2019 Print Date: 2/11/2019 12:59:23PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 2/7/201 <br /> <br /> Home Phone <br /> Address Work Phone <br /> E-Mail Address nudanudall@yahoo.com <br /> Nature of complaint: <br /> COMPLAINANT ALLEGES EMPLOYEES DO NOT WASH THEIR HANDS,BASKETS ARE NOT CLEANED OUT,USING THE SAME TOWEL FOR <br /> SANITARY MAINTENANCE, NOT WEARING GLOVES,AND CASHIER WAS HANDLING MONEY AND FOOD AT THE SAME TIME <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 /> kInternet/Email S-Sheriffs Office <br /> ---- -------------------------------------------- - - <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facilitv: FA0004641-CAROLINAS GRILL RP DBA <br /> Site location 4555 N PERSHING AVE STE RP mailing address <br /> STOCKTON,CA 95207 <br /> Cross Street <br /> Mailing address RP contact <br /> STOCK'rON,CA 95207 RP contact phone <br /> Phone 209-474-0386 EXT: <br /> Owner: OW0015183-SERGIO ANGULO <br /> DBA CAROLINAS GRILL <br /> Owner address 2406 HANNA BAY CT <br /> STOCKTON,CA 95210 <br /> Billing Address 2326 FEDELIA CRT <br /> STOCKTON,CA 95210 <br /> Home Phone 209-951-3972 <br /> Work Phone 209-474-0386 EXT: <br /> District 002-MILLER,KATHERINE Location Code <br /> APN <br /> Date Abated 2 t( Inspector ID#: Flo 11 r_s `w 47_ <br /> -------------------------------------------------- - <br /> Send Referral to `1 Referral Letter Sent by <br /> Referral Address Date. <br /> Complaint Status Code: Q D <br /> Circle appropriate Status Code <br /> 01 -Field Response-Violations Cited and Corrected 29-Alleged FBI-Major Violations Identified <br /> 02-Office Response Only 50-LEAD Assessment Performed-No Abatement Required <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 52-LEAD Abatement Reqired-See Program Record File <br /> 07-Referred to Other Agency 97-Disaster Planning and Response <br /> 008 Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 0-POSTED SUBSTANDARD/UNSECURED-See Housing File MN-EHD Monitoring Status <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# PD-Permit Issued-Pending Well Installation <br /> 12-DA Referred Complaint-See Program Enforcement Action Form RS-Resolved-New Well Installed <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 28-Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> omplaint Reviewed by: (ES <br /> I ate: Up ate by: t 41 l <br /> 5104.rpt <br />