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CO0012411
Environmental Health - Public
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1600 - Food Program
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CO0012411
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Entry Properties
Last modified
9/4/2020 3:54:35 PM
Creation date
2/11/2019 10:28:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
RECORD_ID
CO0012411
PE
1624
FACILITY_ID
FA0002515
FACILITY_NAME
DE VINCIS DELICATESSEN
STREET_NUMBER
4555
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
ENTERED_DATE
6/14/1999 12:00:00 AM
SITE_LOCATION
4555 N PERSHING AVE 21
RECEIVED_DATE
6/14/1999 12:00:00 AM
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\P\PERSHING\4555\CO0012411.PDF
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EHD - Public
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Date run , 06/14/"09 SAN JOAOUIN COUNTY PUBLIC HEALTH SER'VIC Report #5104 <br /> Run bl CAROLD X Page # 1 <br /> Copy #i = 01 cif 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = COO12411 Program/ElementyFSAd� � <br /> Take. Ly : 7329 GAGA7A Date. 06/14/99 Assigned to 0794 MATHEW Date: 06/14/99 <br /> Hard copy Printed: <br /> Facility Name. DE VINCIS DELICATESSEN Fac ID : 002515 <br /> ................_.._-___ <br /> BILL to inventoried FACILITY: <br /> Location= 15C5 Vv PEF;311IPJG AVE 2.1 <br /> (Must have FACILITY ID#) <br /> Ccmplainarrt : JOANN COWGER ___ ...... -_Home Phone : 209-483-1855 <br /> Arldre�LWork Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name = DE VINCIS DELICATESSEN Loo Code = 01 <br /> Address : 455S ' N PERSHING AVE 21 BOS Dist . 002 <br /> City : STOCKTON 95207 APN # <br /> ......................_...... <br /> Phone : 209-957 2750 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : DE. VINCIS DELICATESSEN _ Home Phcne = <br /> ��ddress : 4555 N PERSFIING AVE X21 Work Phcne : 209-957-2750 <br /> City : STOCKTON CA 95207 <br /> Nature of Camplaint: <br /> BOUGHT LARGE AMOUNT OF RAVOLIS AT DE VINCIS AND 15 OUT OF 20 PEOPLE <br /> SERVED GOT WITH NAUSAU , VOMTTTING , DIRREAH <br /> COMPLAINT Info — <br /> COMPLAINT MODE F' 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. Q4 <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT :nitrated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 03-Nat Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by : - _ Date- W <br /> Circle appropriate Unit k if complaint in another PROGRAM jurisdiction, Have Complaint Record and P;E updated <br /> Forwarded to UNIT: l./ Ii III IV for Investigation <br />
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