Laserfiche WebLink
"141 T PUBLIC Copy # 01 of 0 HEALTH SE RVIC `'` <br /> _ .. COMP Report #51�'�-,rte-�•.E <br /> COMPLAINT INVESTIGATION REPORT Pace # <br /> COMPLAINT # � 1 <br /> Taken by ; 6519 DIS,A 00009041 <br /> Date; 09/22/97 Pro r <br /> Hard COPY Printed 09/22/97 Assianed to : am/EI ement = 1600 <br /> g/< /97 915) BARCELLOS Date 09/22/97 <br /> FacilitY Name : LQC,KY STORE <br /> 0_3,10 Fac ID : 00.0395 <br /> Location: 530 <br /> _LOOT AVE ILL to inventoried FACILITY: <br /> ComP.lainant . BEt..ONr KEwIN (Must have FACILITY ID#) <br /> Address: .... ..... <br /> . <br /> Home Phone = 209--745-m9453 <br /> ................ Work Phone: <br /> FACILITY LOCATION/Property Info <br /> DBA or Name , LUCKY STORE #310 <br /> _..................._.................... ........ ....._ ....... _...... _........_......... <br /> Address: 530....... ...._LQDL.... A'1E Lo <br /> City ' 803 02 <br /> c Code 42 <br /> OD.I.. 95241664 <br /> Phone : 20'9 -539- 7170 APN # <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name . LUCKY STORE INC <br /> . Home Phone : 510--678-4200 <br /> :ddresY " SAN LEANDRC) CA ...945 .. <br /> x.701.. . MARINA BLVD _._. ..._-... .....-... ......... <br /> City. .Work Phone ; 209-339--7170 <br /> 77 <br /> Nat,.r2 of complair.t: <br /> PANS BEING REUSED , NOT CLEANED WELL ENOUGH , SLICER NOT CLEANSE? <br /> PROPERLY . INGREDIENTS INTERCHANGED . <br /> COMPLAINT Info - <br /> =OMPtAINT MODE' P PHONE <br /> A-Agency Referral 9-CD OF Sliaervisors/City Ceouncil C-Counter M-Mail/Correspondence <br /> O-Ot:eer EH Unit P-Phone <br /> rv`':SAINT S MT�'S' o U. <br /> 01-Field Abated y2-Cffice Abated 03-SAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Prea:ase File 67-Refer to Other Agency 08-Hot Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral. Letter Sent by : _ Date: <br /> :e app=onrtate unit � if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> rc�rat ,�i to 01T: � II III IV for Investigation <br />