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Date run: 10/16/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVSC Report #5104 <br /> Run by KAREE Page # 16 <br /> Copy ,# = 01 0 01 ' COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = 00007059 Program/Element 1600 <br /> Taken by : 0626 SHELLY PRATER Date: 10/16/96 Assigned to : 0843 lI.I4MEA -EbftiNS Date: 10/16/96 <br /> Hard copy Printed: fid-•A* <br /> . Facility Name: CHUCK.„.ECHEESE, Fac ID: 002.509. <br /> BILL to inventoried FACILITY: <br /> Location: 4555_ N PE,RSHING, (Must have FACILITY I00) <br /> Complainant: SHELLY......PRAYER..._............................_. Home Phone: <br /> .......__.........._..... _._.__......._......._............. <br /> Address: 83421 Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: Lne Code : <br /> Address: BOS Dist : <br /> ...,:..._._..__... .... _ _..... ............................... <br /> City: _ APN ## <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: Home Phone: <br /> Address: Wnrk Phone: <br /> City, <br /> Mature of Complaint: <br /> BATHROOMS WERE OUT OF ORDER . <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 EH Unit P-Phone <br /> COMPLAINT STATUS: <711-__ <br /> 01-field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enf0rce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit I if complaint in another PROSRAM jurisdiction, Have Complaint Record and PIE updated <br /> Forwarded to UNIT: © 11 111 IV for Investigation <br />