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i <br /> Date run: 07/17/95 CAN JOAQUIN COUNTY PUBLIC HEALTH SERYTC Report 05104 <br /> Run by MARY01( page 4 <br /> Copy # 0n1�' 61� COMPLAINT INVES:TJGATION REPORT <br /> COMPLAINT # = C0004235 Program/Element : 1600 <br /> Taken by : 9051 MARY OSULLIVAN Date: 07/17195 Assigned to : 0794 4,, Date: 07/17/95 <br /> Hard copy Printed: M� <br /> Facility Name Fac ID: <br /> BILL to inventoried FACILITY: <br /> Locations 4555 N PERSHING. AVE--CHUCK&CHEESE (Must have FACILITY IO#) <br /> Complainant : JOHN PAIZ Home Phone : 209-941-9420 <br /> Address : Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: CHUCK & CHEESE 'S PIZZA Lac Cade <br /> _ .. ........ <br /> Address . 4S.5Tj...... ...._PERSHING................................ ... BO5 Diet. <br /> ... ................................................................ ... ...................._.. <br /> City : STOCKTON APN <br /> ._ k <br /> .... ...................... <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : Home Phone : <br /> Address : Work Phone: <br /> ................ ..... ........... ...... .. <br /> City . <br /> Nature of Complaint: <br /> WED . 7/12—HE BEGAN TO GET SICK—DIARRRHE , ORDERED PIZZA ,THEY WERE <br /> VERY SHORT HANDED AND DISH HAND TOWELS WERE VERT' DIRTY . <br /> COMPLAINT Info <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other H 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 /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> Forwarded to UNIT: II III IV for Investigation <br />