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"tlaEe run= 04/29/ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC RRepporrte#514 1 <br /> Run Fly - . CAROLD <br /> Copy # : 01 of 0 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0012167 Program/Element 1624 <br /> Taken by : 6519 DISA Date: 04/29/99 Assigned to : 0321 OLIVEIRA Date: 04/29/99 <br /> Hard copy Printed: 04-39;99 <br /> facility Name : LONG JOHN SILVERS Fac ID : 0007941 <br /> BILL to inventoried FACILITY: <br /> Location: 17 10 N MAIN (Must have FACILITY IDt) <br /> Complainant RES Home Phone : 209-525-6700 <br /> Address : 3800 CORNUCOPIS WAY STE C _ Work Phone : <br /> MODE5TO CA 95358 <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name- LONG I JOHN SILVER5 #5268 Loc Code : 04 <br /> Address : 1110 N MAIN _ _ _ _ BBS Dist : 003 <br /> City : MANTECA 95336 APN # : <br /> Phoma : 209-334-2444 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : LONG JOHN SILVERS INC <br /> <br /> <br /> Nature of Complaint: <br /> ATE 3 SHRIMP , FISH AND FRIES _ DIARRHEA , ABDOMINAL CRAMPS _ <br /> REPORTING PARTY GARY SUND P .O .BOX 20924 CASTRO VALLEY , ( 209 ) 862-1682 <br /> COMPLAINT Info — <br /> COMPLAINT MODE: A AGENCY REFERRAL <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: Q <br /> Ol-Field Abated 02-Office Abated 03-NAI Sent 04-Not to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to other Agency OB- t Valid 09-Foodborne Illness <br /> Send Referral Letter to- <br /> Address: <br /> Referral tetter sent hy : Dat,_ : <br /> k .�mplaint in another PROGRAM iurisdiction, Have Complaint Record and P/E updated <br /> cerwarded to UNI': DI <br /> II III IV for Investigation <br />