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nate run : owloi/9 5AN JUAUUiN UUUN I Y PUtSLIA, h-tt-M I M Z�r_rcV LU Page4IV4 1 <br /> Run by : CAROLD rit <br /> Copy # : 01 of 03. COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : 00011652 Program/Element : �16� <br /> Taken by : 5519 DISA Date: 02/01/99 Assigned-to : 0321 OLIVEIRA Date: 02/01/99 (G -17 <br /> Hard copy Printed: <br /> F=acility Name: ............. 4 ._EXPRESS MrlravQ7M ID : 001.230 <br /> Kill S BILL to inventoried FACILITY: <br /> Location: 4 MAIN (Must have FACILITY ID#) <br /> Complainant : RAUL__.R.U.1.Z.... .S-r............................................................-.._.-.................................-......._..Home Phone :, 209-465-7285 <br /> Address : ... -,,.. Work Phone :,� <br /> FACILITY LOCATION/Property Info <br /> DBA or Name: P.IZZ_A..._EXP ......._.._5....._ Loc Code : 04_ <br /> Address: 429 N N �..E30S Dist : <br /> ......................_....:......................................._. ................. <br /> City : MA. ......._._CA. 95336 APN <br /> Phone: 2 9 -575-2736 <br /> BILLING RESPONSIBLE PARTY or--OWNER Info — <br /> Name : P ERSONS..a...... R _._.__.-_....-....-....-._................................_.........__....._....._............................. <br /> ..... .._Home Phone: 209-575-2736 <br /> Address: 21 _Z _ ........._G... OAK -C .............._.............__.. ......... ....__...Work Phone : 7.09-575--2736 <br /> City : MODES „., ' C-A. 95355 <br /> Nature of Complaint: I <br /> ATE COMBO PIZZA ABOUT 3: 30 PM BECAME ILL ABOUT 20 MINUTES LATER . PAIN <br /> IN STOMACH AND VOIMITING . <br /> i1 <br /> a <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P_.....__PHONE <br /> �I <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: - <br /> field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued OS-Enforce ACT.{Initiated <br /> 06- ransfer to Premise file 01-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> I� <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit 9 if comp t in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> forwarded to UNIT II III IV for Investigation <br /> y <br /> ,1 <br />