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r '0 <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00051557 Site Location: 678 N WILSON WY Account ID: AR0004645 <br /> Received by: EE0009830 SAUERS Received Date: 2/5/2020 Print Date: 2/5/2020 9:15:51AM <br /> Assigned To: EE0009832 ACEVEDO Assigned Date: 2/5/2020 <br /> Program/Element Code 1600-FOOD PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of com taint: <br /> COMPLAINANT ALLEGES THEY CONSUMED SHRIMP FROM THIS FACILITY MONTH AGO AND BECAME ILL.ALLEGES THEY CAN'T <br /> BREATHE AT NIGHT AND THEY FEEL LIKE THEY HAVE FLUID IN THEIR LUNGS <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:FA0002463-PAQ Inc.DBA Food-4-Less RP DBA <br /> Site Location 678 N Wilson Way RP mailing address <br /> Stockton,CA 95205 <br /> Cross Street <br /> Mailing address 1793,Murphy Parkway RP contact <br /> Lathrop,CA 95330 RP contact phone <br /> Phone 209-466-2751 EXT: <br /> Owner: OW0001562-PAQ Inc. <br /> DBA <br /> Owneraddress 8014 LOWER SACRAMENTO RD STE 1 <br /> STOCKTON,CA 95210 <br /> Billing Address 17935 Murphy Parkway <br /> Lathrop,CA 95330 <br /> Home Phone 209-957-4917 <br /> Work Phone 209-858-0101 EXT: 336 <br /> District 001 -VILLAPUDUA,MIGUEL Location Code 01 -STOCKTON <br /> APN 14129007 <br /> Date Abated -L'&/2U Inspector ID#: ktwt�/o <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:21b <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 /> 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 /> X15--ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 128-)Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> omp aint Reviewed by: .7` ate: pate y:�� \ � ate:-7A <br /> �2 V <br /> 5104.rpt V I (/l� <br />