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f - •�'S�� J:.i rti�..iv i:�i �VVIY l 7 '"Vl.:sJ1�.t'r 1l. <br /> Run by 1 CAROLC, Page # 3 <br /> copy--r—l' 01 of Y COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0009065 Program/Element : 1600 <br /> Tater by ' 0794 MATHEW Date: 09/19/97 Assigned to : 0794 MATHEW Date: 09/24/97 <br /> Hard copy Printed: <br /> Facility Name : EDENSQUARE CAFE Fac ID - .02922, <br /> _. , .... <br /> BILL to inventoried FACILITY: <br /> Location: 947 N EL DORADO :;T (Must have FACILITY 101 ) <br /> Comp 1�ii nant • <br /> <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DESA or Name' EDEN... SQUARE E........................................................ .. .. . Loc Code 01 <br /> Address : 947 N EL DORADO ST.....:...........:.......................... BOS Dist <br /> ............................._........._ <br /> City . STOCK.TON 95202 APN # <br /> Phone: 209-465-1227 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name; AQUI,LE R_A...r.......pA'�_I_�.............................................................. ...... - ....._.................._Home Phone : 209--463-1813 <br /> Address= 947 N EL DORADO STWork Phone: 209-462--732€ <br /> - ................................................................. <br /> City - STOCKTON CA 95204 <br /> Nature of Complaint: <br /> ON SEPT 10 AT 12 : 00 ATE VEGGIE SANDWICH WITH ALFALFA SPROUTS . BECAME <br /> ILL NEXT DAY WITH DIARRHEA , VOMITING , CRAMPS . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: i PhONE <br /> A-Agepcy Referral B-BO OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> -OMPLAIN3 STATUS: <br /> D1-Fie.d Abated C2-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Pramise File 07-Refer to Other AGency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Ref;2r'r al Letter Sent by Date- <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE update° <br /> Forwarded to UNIT: II III IV for Investigation <br />