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- <br /> - run, 08/02 AN 3OAQUIN �OUNTY PUBL IC HEALTH SERVIC Rspmt 95104 <br /> Run by : MARY 0 Page <br /> Copy 4 ""' 01 nf , 01 COMPLAINT INVESTIGATION REPORT COMPLAINT C0004339 CO0O4339 PTo8ram/Elc�ment 1600 <br /> Taken by : 9051 MARY 0SULL[VAN Date: 07/01/95 Assigned to : 0794 KAJU MATH[U Date! 07/01yB <br /> Hard copy Printed: <br /> Facility Name : _ Fac ID, <br /> BILL to inventoried FACILITY: <br /> Location: 4��� 1� T�E��HZN� AVE—CH�C.K._� C-HEF (Fast have FACILITY DDC ---- <br /> ComplainantPAULA _ ... Home Phone : 209-333-6244 <br /> Address- Work Phone" <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: _Loo Code' : <br /> Addressii <br /> City : _ APN 4 « <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Mame' � _ _ _ Home Phone : <br /> Address: _ _ _ _ Work Phone , <br /> City : <br /> Nature ofComp]miot: <br /> VERY DIRTY—THE GAME ROOM SMELLED LIMED FECES , MADE HER THROW UP , THE <br /> WHOLE PLACE SMELLED . PIZZA HAD HARD ITEMS IN IT ( OLD DRIED CHEFSF ) <br />. COMPLAINT Info — <br />` COMPLAINT MODE: P PHONE <br /> ' <br />� A-Agency Rofexm1 B-OD Of 6up rviSwm/City Cmonoil CfOunhF K'Hail/Co respoWen:o <br />. 0'0tke, EH Unit P-Phune <br />> <br />� COMPLAIMTSTAIUS:��\/ <br /> up <br /> ` <br /> 01-Field Abated 32-Offi:o Abated 03-NAI Sant o Abate Issued 05-[8ftvno ACT Initiated <br /> ^ <br /> 06-Transfer to Mamioa Film 07-Refer to Other Agmn t Valid 09-Fuudbwnv Illness <br />. - <br />. . <br /> . . <br /> Circle appvsviatz, Unit 4 if ooe laint in another PROGRAM juriadiotion. have Conpla|it Record and PIE updated <br /> Forwarded to U �` � lI Ill IV forinvestigation~ � <br /> - ' <br />