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Date run: 05/18/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 <br /> Run by : CAROLINE Page it 2 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> MJ•f.Af.�tMMMFfMffhfMldAlM.M.+�f.MMMMhtM.nlMMl4A?Mr*A!.MI.+MIfMfNIfM.MMM.�MMh!MMII�!M.M.Mhf.1!.Mt!.MflMMMI�MIfMM.nfFfM.MpI.M.�+IM.h!M.� <br /> COMPLAINT P : C0001890 Pragram!Element : 1600 <br /> Taken by : 2115 CAROLINE NASCIMENTO Date: 05/18!94 Assigned to 0102 ASTEV4INDT Date: 05/18/94 <br /> Facility Name: OLDE TYME COOKIES/BURRITOS Fac ID: 002901 <br /> BILL to inventoried FACILITY: <br /> Location: 5308 PACIFIC AVE #7 R B (Must have FACILITY ID#) <br /> Complainant: <br /> <br /> FACILITY LOCATION/Property Info <br /> DSA or Name: OLD TYME COOKIES BURRITOS Loc Code 01 <br /> Address: 5306 PACIFIC ROS Dist 002 <br /> City: STOCKTON APN # ; <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name: Home Phone: <br /> Address: Work Phone. <br /> City. _ <br /> Nature of Complaint: <br /> ATE PORK BURRITO ON a!20/94-BECAME ILL W/FOOD POISONT-NG(SAW DR.PUZON) <br /> LAB CONFIRMED-SHE ISN'T SURE IF DOCTOR REPORTED;ALSO SHE NOTICED THE <br /> HELP WAR USINr 1 SPOON TO DIP INTO OTHER DISHES, MEAT TO D.4IRY,ETC. <br /> CQMPLAINT Info - <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil G-Gaunter M-Mail!Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 05-Transfer to Premise File 07-Refer to Other Agency 08-Nat Valid 09-Foodborne Illness <br /> r <br /> Circle appropriate Unit 0 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E update,d <br /> r <br /> Forwarded to UNIT: I II III IV for Investigation <br /> J. <br />