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7 : = ! 7c'AQUIN COUNTY PUBI—Ir' HEALTH 5ERVIw Report #5104 <br /> Run by CAROLD (� Page # 1 <br /> Copy # = 01 of 3A 1 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # 00009002 Program/Element 1600 <br /> Taken by , 4418 !KITH 'Date: 49/16/97 Assigned to : 0794 MATHEW 0ete: 09/16/97 <br /> Hard COPY Printed' <br /> Facility Name: ASIAN SUPERMARKET Fac ID : 002514 <br /> BILL to inventoried FACILITY: <br /> Location: 4 iii_PE P t-JTNG #16 {Must have FACILITY ID#} <br /> .-Illpl:iindnt ' ANON Home Phone: <br /> Address. Work Phone : <br /> FACILITY LOCATION/Property Info <br /> DBA or Name= ASIANSUPERMARKET Loc Code 01 <br /> ................. - ........... <br /> Acddi 4.5 5...-N. PERSHING,- 16.. ._.........._..BOS Dist <br /> cit'/ 3TOCKTON 95207 APN it <br /> Phone• - 209--957-3097 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : UNG , ALICIA Home Phone : 209-952-3508 <br /> Address , 8667 MARINERS DR #t67 Work Phone: 2039-957-3097 <br /> City ' STOCKTCN r-A 95219 <br /> Nat:- a �f -,omplai:t <br /> PURCHASED CHOW MEIN ON SATURDAY . THE FOOD SMELLED AND TASTED ROTTEN . <br /> COMPLAINT Info — <br /> COMPLAINT MOLE: P ?HANE <br /> 4-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> ;CypLAIN` S'AT'JS C)� <br /> 7.-Fie:d Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 46-Transfer to Premise File 07-Refer to Other Agenc; 06-Not Valid 09-Foodborne illness <br /> Send Referral Letter to: <br /> Address: <br /> Ref6rral Letter rent by: Date : <br /> -rcle apprupr ate ;unit co.-,Plaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNI?' .I III IV for '.nvestigation <br />