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CO0008322
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1600 - Food Program
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CO0008322
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Last modified
9/4/2020 1:13:08 PM
Creation date
2/8/2019 8:20:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
RECORD_ID
CO0008322
PE
1619
FACILITY_ID
FA0000833
FACILITY_NAME
LUCKY DISCOUNT CENTER MKT #186
STREET_NUMBER
1172
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
ENTERED_DATE
5/29/1997 12:00:00 AM
SITE_LOCATION
1172 N MAIN ST
RECEIVED_DATE
5/28/1997 12:00:00 AM
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\1172\CO0008322.PDF
Tags
EHD - Public
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Date run: 05/29/97 N JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #1104 <br /> Run by : CAROLD Page # 1 <br /> Co`'1ry 0" : 01 of �1 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0008322 Program/Element 1600 <br /> Taten by : 9519 CAROL DISA Date: 05/29/91 Assigned to : 5156 ERNESTO JACOBO Date: 05/29/91 <br /> Hard copy Printed: 05/29/91 <br /> Facility Name : LUCKY DISCOUNT CENTER MKT #186 Fac ID: 000833 <br /> BILL to inventoried FACILITY: <br /> Location: 1172 N MAIN ST (Most have FACILITY IDf) <br /> Complainant : MR. JOHNSON / Home ho • 209-823-2166 <br /> Address : 3435 MARFARGOA Work Phone: <br /> ?, A <br /> FACILITY LOCATION/Property nfo — gg33p <br /> DBA or Name: LUCKY DISCOUN R MKT #186 _Loc Code : 04 <br /> Address : 1172 N MAIN ST _ BOS Dist : 003 <br /> City: MANTECA 95336 APN # <br /> Phone: 510-678-4200 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : LUCKY STORE INC Home Phone: 510-678-4200 <br /> Address : 1701 MARINA BLVD _ Work Phone: <br /> City : SAN LEANDRO CA 94577 <br /> Nature of Complaiat: <br /> BOUGHT HALIBUT AT LUCKY. COOKED THAT NIGHT FOUND 4 WORMS IN IT. TOOK <br /> BACK TO STORE, THEY DID NOT SEEMS TO CONCERNED. <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PRONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other IN Unit P-Phone <br /> COMPLAINT STATUS: l (� <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 01-Refer to Other Agency 01-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit I! if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: 0 11 111 IV for Investigation <br />
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