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i Date run: 10/28/94 SAN JOA0UIN COUNTY PUBLIC HEALTH SERVIC Report #5104 Run by : KAREN/Ga- Page # 4 copy # 01 of 01 COMPLAINT INVESTIGATION REPORT COMPLAINT ## 00002833 Program/Element :1600 Taken by : 1562 LORETTA DUNHAM Date: 10/28/94 Assigned to : 3913 Date: 10/28/94 Hard copy Printed:. Facility Name: ........... Fac ID : BILL to inventoried FACILITY: Location= X616MARCH LANE (Must have FACILITY IDO Complainant: FACILITY LOCATION/Property Info - 309 ... ................._................... Loc Code : 01 DBA or Name: LUCKY #._._......__......_........._........._.........._. ..... Address: 1,6.1,6, MARCH....__LANE................ BOS Dist 001 City " ............_._............................_._...........................__..._... .............................._.... S,T 0 C K T C7 N ..__........._ APN # : Phone : BILLING RESPONSIBLE PARTY or OWNER Info — Name ..............._.... ................. .................. ................. ................................ Home Phone Address : ................._..........._._...._.........._..._....................._............ Work ...... Phone : City : Nature of Complaint: *&tS� FOUND IN "RICEARONI " AND "RICE CHEX" . D COMPLAINT Info COMPLAINT MODE: FPHO NE Q�G, A-Agency Referral 8-BD OF Supervisors/City CCOUnCil C-Counter M-Mail/Correspondenck/V`k� �9Q 0-Other EH Unit P-Phone pFj�'MN S 2TV�yFq COMPLAINT STATUS: O1-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness Circle appropriate Unit q if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated forwarded to UNIT: IO II III IV for Investigation