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,�3L <br /> ' Re Com Complaint Investigation Form ort#:5104 <br /> p 9 p <br /> COMPLAINT ID: C00050236 Site Location: 8023 WEST LN Account ID: AR0004856 <br /> Received by: EE0000014 MORENO Received Date: 7/31/2019 Print Date: 7/31/2019 3:25:09PM <br /> Assigned To: EE0001084 RAMIREZ Assigned Date: 7/31/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> E-Mail Address <br /> Nature of com laint: <br /> COMPLAINANT STATES SHE WENT TO FACILITYAND PURCHASED CHICKEN STRIPS AND THE CHICKEN WAS MOLDY,THIS IS THE <br /> SECOND TIME THIS HAS HAPPENED TO HER AT THE SAME LOCATION.COMPLAINANT REQUEST CALL BACK. <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-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility:FA0002725-CHURCHS CHICKEN#5773 RP DBA <br /> Site Location 8023 WEST LN RP mailing address <br /> STOCKTON,CA 95210 <br /> Cross Street HAMMER <br /> Mailing address 6248 PACIFIC AVE RP contact <br /> STOCKTON,CA 95207 RP contact phone <br /> Phone 209475-1547 <br /> Owner: OW0010559-H&R FOODS INC <br /> DBA CHURCH'S CHICKEN 45773 <br /> Owner address 6248 PACIFIC AVE <br /> STOCKTON,CA 95207 <br /> Billing Address 6248 PACIFIC AVE <br /> STOCKTON,CA 95207 <br /> Home Phone 661-703-7298 EXT: CELL <br /> Work Phone 209-475-1547 EXT: BUSINESS <br /> District 003-PATTI,TOM Location Code 01 -STOCKTON <br /> APN 08818,0,0'77 <br /> Date Abated r t,;C& �z G� Inspector ID <br /> --- t/y-4-- -- — ----- <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 /> IS <br /> 8 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 /> omp amt Reviewed by: a` ate: pate y: at i r <br /> a/CJ t t <br /> 5104.rpt <br />