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.,ate run: 02/04/9 SAN JOAQUIN COUNTY PUBLIC :HEALTH SERVIC Report 05104 un by CAF Page # 1 ell"C' # 01 0t 01. COMPLAINT INVESTIGATION REPORT COMPLAINT # : COOO7619 Program/Element : 1 Taken by : 0628 SHELLY PRATER Date: 02/04/97 Assigned to : 0740 BRUCE ASKANAS Date: 02/04/97 1&0 Hard copy Printed: Facility Name: R.O.UIVD TABLE_....P.IZ A Fac ID: 00.1.793. BILL to inventoried FACILITY: Location: 3201_---...W....._PEN JAM_I_N.....HOLT #91. (Must have FACILITY IDO) Complainant: ANI..1".A.._.-.................................. .-Home Phone : 209-467-1.559 Address= _Work Phone : FACILITY LOCATION/Property Info — DBA or Name: ROUND TABLE .. .................. .Loc Code : 0.1.. .... . . ........ Address • - 3201 W....._B£NJAM.IN .HtiL7 #9.1......, ....._-. .................... BOS Dist : City: 3TOCKTON 95219 APN # Phone : BILLING RESPONSIBLE PARTY or OWNER Info Name . HAM...._PI_ZEA_,........I.NB..-..................................................._.................................._...._.................................Home Phone: 209--333-3755 Address: 628........_......._CENTTRA�-....._AVE................:..............................-_.._................._......................................_Wor k Phone: City: T'_RACY_ Q.A. 95376 Nature of Complaint: ATE COMBO PIZZA . FEBRUARY 1 ST 1997 , 2 HOURS LATER BECAME SICK . CRAMPS COMPLAINT Info — COMPLAINT MODE: PPHONE ........... A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence 0-Other EH Unit P-Phone COMPLAINT STATUS: 01- ield Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated THOU to Pr-emise File 87-Refer to Other Agency 98-Not Valid 09-Foodborne Illness Circle appropriate Unit d if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated Forwarded to UNIT: II III IV for Investigation