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Date run= 10/27/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 Run by KAREN/CB Page # 3 Copy # - 01 of 01 COMPLAINT INVESTIGATION REPORT COMPLAINT # = C0002827 Program/Element Tahn`by : 3304 KAREN ARMSTRONG Date: 10/27/94 Assigned to : 7479 4i%6"*E Date: 10/21-79 ' Hard copy Printed: w Facility Name: SAFEWAY....._MARKET.......&,..._BAKERY..._.#_1.59. Fac ID: 0o2.q...6" BILL to inventoried FACILITY: Location= 2720 COUNTRY .CLUB (Must have FACILITY IO#) FACILITY LOCATION/Property Info — DBA or Name: SAFEWAY Loc Code : 99 .............__._......_..........................................................................................._............_..............................._._............................................................. ............ Address- 2720 COUNTRY CLUB BOS Dist : 001 T Q N.................... ....................._._.............._.........._................._.................__......................._.. S.T.aC K City: APN # Phone: 209-951-3749 BILLING RESPONSIBLE PARTY or OWNER Info — Name : SAFEWAY STORES Home Phone : Address: Work Phone: 209-951-3749 ......................_..........................................................._................................................................_............................................... City- .......... Nature of Complaint: 14 CASES MEAT THAWING AT RM TEMP ( 7 CASES ON FLR ) ; MEAT ON TABLE WAS DRIPPING INTO PANS; SOAP STORED ABOVE MEAT; FOAM COMING OUT OF WALL . G s COMPLAINT Info COMPLAINT MODE: p... A-Agency Referral B-8D OF 5uperuisors/City CCOVncil C-Counter M-MaillCorrespondence D02-Office Unit P-Phone COMPLAINT STATUS:t a e 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 # if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated Forwarded to UNIT: © II III IV for Investigation