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Run b CAROLD Page # 2 <br /> Co'ey #f 01 of 1 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0012345 Program/Element : 1624 <br /> Taken by : 6519 DISA Date: 06/01/99 Assigned to : 0321 OLIVEIRA Date: 06/02/99 <br /> Hard copy Printed: <br /> Facility Name : LONG JOHN SILVERS #5268 Fac ID : 000794 <br /> BILL to inventoried FACILITY: <br /> Location: 1.1„1C_......._..,N._..MAIN. (Must have FACILITY IDt) <br /> Complainant : JOE MEATH CITY OF MA_NTECA __. __Home Phone : 209-239-8421 <br /> Address: Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: LONG JOHN SILVERS #5268 Loc Code : 04 <br /> .... . - - ....._._ <br /> Address : 1110 N MAIN BOS Dist : 003 <br /> City : MANTECA 95336 APN # <br /> Phone : 209--334-2444 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : LONG JOHN SILVERS INC <br /> <br /> <br /> <br /> Nature of Complaint: <br /> FIRE AT THE FACILITY . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <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: 01 <br /> Qield Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT ,nitiated <br /> -Transfer to Premise File 07-Refer to Other Agency OB-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by : Date : _ <br /> Circle appropriate Unit 0 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: II III IV for Investigation <br />