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Bate run. 11/28/94 SAN JOACUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> ,�i3c�ra, IDy : CAROLINEl9�_ Page # 1 <br /> Copy # 01 of 01 COMPLAINT INVESTIGATION REPORT � G <br /> COMPLAINT # = 00002966 Program/Element = 1626 <br /> Taken by : 0794 RAJU MATHEW Date: 11/28/94 Assigned to N Data: 11/28/94 <br /> Hard copy Printed: <br /> Facility Name Fac ID : <br /> BILL. to inventoried'FACILITY: <br />` Location: 6?7._.._PACI_FI..G......�?YE.N.UE.. (Must have FACILITY IDO <br /> Complainant : K.AR.'T.-AR�`N......Mt�NTOYA.........................._ ..... ......_dome Phone: 510-803-0331 <br /> Address: -__ Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : PEGASUS RESTAURANTLoc Code : 99 <br /> ..................................................................._.................................... <br /> Address : 7627 PACIFIC AVENUE BOS Dist : <br /> ..............._................................................_........._....._.._..........................................._.........._.._..........,...._.............._ <br /> .._.............................. <br /> City : S_-OQKT.ON, 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 /> COMPLAINANT - ATE CLAM CHOWDER AT 2 : 00 P .M . ON .11/25/94 AT 3: 30 P .M . <br /> BECAME ILL tSTOMACH CRAMPS & VOMITING ) NO DOCTOR VISIT/NO SAMPLES; <br /> PLEASE NOTIFY COMPLAINANT AFTER INSPECTION . <br /> COMPLAINT Info - <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-CoVnter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: LI <br /> D6-T <br /> field Abated 02-Office Abated 03-NAI Sent 04-Noti zsuO 05-Enforce ACT Initiated <br /> ransfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> Forwarded to UNIT: QI 11 III IV for Investigation <br />