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Date run: 01/03/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by : MARYO Page # 3 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0005265 Program/Element 1600 c:74 <br /> Taken by : 0740 BRUCE ASKANAS Date: 01/03/91 Assigned to : 0740 BRUCE ASKANAS Date: 01/03/95 <br /> Hard copy Printed: <br /> Facility Name : Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location= 1.�Q.(ap._ .yWY.....gg_ (Must have FACILITY 100 <br /> <br /> <br /> : -- <br /> FACILITY LOCATION/property Info — <br /> DESA or Name: JACKPOT....._FOODS.................. _................._._ <br /> ._.......__._._............................ . ..............._ <br /> Loc Code... <br /> 00 : EHW8 ......_....Address <br /> City* . . ,_.. ....._ _..........................................................._................_........ OS Dist <br /> APN # <br /> Prone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : ..................... .... <br /> Home Phone : <br /> .........:_.................................._....................._........................... _._.............._..._................................. <br /> . ...._......._.... <br /> Address: Work Phone: <br /> City : .................. <br /> _ <br /> Nature of Complaint: <br /> FIRE AT FACILILTY ON 1/2/96 <br /> COMPLAINT Info — <br /> COMPLAINT MODE: 0 OTHER EH UNIT <br /> .................. <br /> A-Agency Referral 9-80 OF Supervisors/City CCOunCil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: ...... <br /> C01-Field Abat 02-Office Abated03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> r to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit A if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: II III IV for Investigation <br />