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Complaint Investigation Form Report#:5104 <br /> G'OMPLAINT ID: C00050436 Site Location: 2808 COUNTY CLUB BLVD Account ID: AR0041583 <br /> Received by: EE0000025 SEDRA Received Date: 9/6/2019 Print Date: 9/6/2019 2:07:24PM <br /> Assigned To: EE0003361 FLOHRSCHUTZ AssignedDate: 9/6/2019 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> COMPLAINANT WAS AT FACILITY ON 09/04/19 AT APPROXIMATELY 6:30PM AND NOTICED THE MENS RESTROOM WAS"FILTHY". PLEASE <br /> CALL COMPLIANT WITH FINDINGS. <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 0-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------- - <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Facility: FA0022709-SAFEWAY STORE#1769 RP DBA <br /> Site Location 2808 COUNTRY CLUB BLVD RP mailing address <br /> STOCKTON,CA 95204 <br /> Cross Street FONTANA <br /> Mailing address PO BOX 29096 MS 6516 RP contact <br /> PHOENIX,AZ 85038 RP contact phone <br /> Phone 209-461-5555 <br /> Owner: OW0000429-SAFEWAY INC <br /> DBA <br /> Owner address 5918 STONERIDGE MALL RD <br /> PLEASANTON,CA 94588 <br /> Billing Address PO BOX 29096 MS 6516 <br /> PHOENIX,AR 85038-9096 <br /> Home Phone 925-467-3000 <br /> Work Phone <br /> District 003-PATTI,TOM Location Code 01 -STOCKTON <br /> APN 12118043 it(�! k L <br /> Date Abated l .0 Inspector ID#: Flo�I � .�U4 7 Z <br /> Send Referral to / r! Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 08 <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 /> 00-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 /> 08 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 /> fto omp amt Reviewed b Cl ate: Date G <br /> 5104.rpt V N <br />