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-�- -�- � FAX SENT #PGS <br /> ✓ = To �/P1�.�.n.ci CG( DATE <br /> FAX#- R-7-0 7 2' TIME <br /> Dale run: 10/05/93 SAN JOA SENTBY /r Recon ; iO4 <br /> Aq? l?�✓� AVERY FXAGS Page <br /> r 1 <br /> Run by : CAROLINE <br /> Copy #7 : 01 of 01 COMPLAINT INVESTIGATION <br /> MMMMMM��IMMMMtlMMAlMMMMMMMMMM!�iMA1A1MMMM1fMM1�IMMMMMMMMMMh1MMMMAfMMMMMMMMMMMMMMMAtMMMMMMMMMM 1 <br /> COMPLAINT # : CO000809 Program%Element : 1,617 <br /> TaVen by : 2116 CAROLINE. NASCIRENTU Date: 10/05/93 Assigned to Date: 10105/93 <br /> Facility dame : LUCKY MARKET #309 Fac ID: 001709 <br /> SILL to inventoried FACILITY: ------- <br /> Location: <br /> _____Location• 1616 E MARCH LN (Must have FACILITY M1 <br /> Complainant : Home Phone : <br /> Address : �� Work Phone : <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name : LUCKYS Loc Code 01 <br /> Address : 1616 E.MARCH DOS Dist <br /> City: STOCKTON APN # <br /> Phone : <br />' BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name : Home Phone : <br /> Address : Work Phone : <br /> City: — lheG_f ,� r,1el.! 67 1°1""A-4 <br /> Nature of Complaint: <br />` PURCHASED CAKE @ LUCKYS ,BAKED BY LUCKYS & PACKAGED BY LUCKYS-DATE ON <br />` PKG. 10/11/93 -SHE ,HER DAUGHTER, & HUSBAND ATE CAKE, ALL 3 ILL, HUSBAND <br /> IN D . L } USP .@ PRESENT W/FOOD POISONING . PLEASE CALL COMPLAINTANT ,AS <br /> TO WHERE SHE CAN HAVE CAKE TESTED-HOSP.TOLD HER SHE COULD HAVE TESTED. <br /> — -- r=od '� . <br /> U <br /> COMPLAINT Info - <br /> CORPLAINT NODE: <br /> A-Agency Referral B-BD OF Supervisors/City %ouncil C-Counter 9-!fail/Correspondence <br /> U-other E1 Unit P-Phone <br /> COHPLAINT STATUS: <br /> 01-Field Abated 02-office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise Pile 07-Refer to Other Agency 08-Nat Valid 09-Foodborne Illness <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, :lave Complaint Record and PJR updated <br /> Forwarded to UNIT0II III IV for InvestiGation <br />