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v ' Form Complaint Investigation F <br /> pO Report#:5104 <br /> COMPLAINT ID: C00049588 Site Location: 4555 N PERSHING AVE STE#18C Account/D: AR0004994 <br /> Received by: EE0000467 CARRUESCO Received Date: 4/4/2019 Print Date: 4/5/2019 8:55:53AM <br /> Assigned To: EE0003361 FLOHRSCHUTZ Assigned Date: 4/4/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT WAS IN THE FACILITY ON TUESDAY APRIL 2,2019 DURING LUNCH AND NOTICED MANY UNPLEASANT THINGS. OBSERVED <br /> A COCKROACH WALKING AROUND THE SALAD BAR,A FEMALE EMPLOYEE GRABBED IT WITH A NAPKIN AND CONTINUED TO WORK <br /> WITHOUT WASHING HER HANDS OR SANITIZE ANYTHING.THE COOK WAS SWEATING AND WIPING HIS FOREHEAD WITH BARE HANDS <br /> AND CONTINUED COOKING. ALSO SAW RANDOM PEOPLE WALKING BACK AND FORTH TO THE KITCHEN THAT DIDN'T APPEAR TO BE <br /> EMPLOYEES. THEY WERE EATING FOOD WITHOUTANY PROPER FOOD HANDLING. <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 0-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriff's Office <br /> --------------------------------------- - - - -- - ------ <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0004641-CAROLINAS GRILL. RP DBA <br /> Site Location 4555 N PERSHING AVE STE RP mailing address <br /> STOCKTON,CA 95207 <br /> Cross Street MARCH LN <br /> Mailing address 4555 N PERSHING AVE,STE 18C RP contact <br /> STOCKTON,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 01 -STOCKTON <br /> APN 11017001 <br /> Date Abated Li—l b.-( � Inspector ID#: !©h r`jGhvLtZ <br /> -------------------------------------------- - -- -- - <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <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 /> 0-Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 10-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: ( t ate: Dat <br /> 5104.rpt l <br />