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colt, i ID: C00055299 <br /> <br />Complaint Investigation Form <br /> <br />Report #. 5104 <br /> <br /> <br />Site Location: 3255 W HAMMER LN <br /> <br />Account ID: AR0001889 <br /> <br />Received by. EE0009830 SAUERS <br />Received Date: 10/17/2022 Print Data: 10/17/2022 1:19:59PM <br />Assigned To: EE0001084 RAMIREZ Assigned Date: 10/17/2022 <br />Prooram/Element Code 1600- FOOD PROGRAM <br />Complainant: <br /> <br />E-Mail Address <br />Nature of complaint: <br />COMPLAINANT ORDERED FOR TAKE OUT ON 10/8/22 SOMETIME IN THE AFTERNOON. COMPLAINANT ORDERED CHICKEN CHOW FUN, (NO0C <br />CHICKEN AND VEGETABLES), AND CHICKEN FRIED RICE, (CHICKEN, RICE, EGG, AND VEGETABLES.) COMPLAINANT'S DAUGHTER DELIVEREC <br />THE ORDER. COMPLAINANT PLACED A SMALL AMOUNT OF THE FOOD IN A BOWL TO CONSUME AND PLACED THE REST IN THE REFRIGERAT <br />UPON CONSUMING FOOD, COMPLAINANT BEGAN TO EXPERIENCE PROBLEMS WITH BREATHING AND A LITTLE BIT OF NAUSEA. COMPLAINA <br />HEATED UP MORE OF THE FOOD LATER IN THE EVENING AND BECAME MORE SICK. COMPLAINANT HEATED UP MORE AFTERWARDS AND WI <br />INTO WHAT THEY DESCRIBE AS ANAPHYLACTIC SHOCK AND FOOD POISONING. THEY HAD SHORTNESS OF BREATH, NAUSEA, CHILLS, VOMI <br />AND DIARRHEA. COMPLAINANT STATES THAT THEY ARE ALLERGIC TO SHELL FISH AND INFORMED THE EMPLOYEE THAT WAS TAKING THE <br />ORDER OF THAT AND TO NOT USE THE SAME UTENSILS AND TO CLEAN GRILL BEFORE PREPARING FOOD ON GRILL THAT SHELL FISH WAS <br />PREPARED ON. COMPLAINANT WENT TO DAMERON EMERGENCY ROOM ON 10/8/22 IN THE EVENING AND THEN WENT TO PRIMARY CARE <br />PHYSICIAN. <br />***PLEASE CALL COMPLAINANT. <br />Complaint Mode: P Complaint Mode Codes A-Agency Referral <br />E-Code Enforcement <br />I-Internet / Email <br />B-Bd of Supervisors / City Council <br />M-Mail / Correspondence 0-Other EH Unit <br />S-Sheriff's Office <br />C-Counter <br />P-Phone <br />F-Fax <br />PROPERTY INFORMATION <br />Facility: FA0001882 - CHOW TO GO CIIINESE RESTAURANT <br />Site Location 3255 W HAMMER LN <br />STOCKTON, CA 95209 <br />Cross Street <br />Mailing address <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />District 002 - MILLER, KATHERINE Location 01 - STOCKTON <br />APN 08222013 <br />Date Abated <br /> <br />Inspector ID #: <br /> <br />jZ-avvvt1rt:, <br /> <br />Send Referral to Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: <br />Circle appropriate Status Code <br />5104.rpt