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vat, . Uw 06,`21/99 AN JQAQUIN COUNTY PUBLIC HEALTH SERVIC Report 15104 <br /> Run by : CAROLD Page # 1 <br /> Copy # : Q1 of 0 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = CO 12459 Program/Element : 1635 <br /> Taken by : 6519 DISA Date: 06/21/99 Assigned to 0467-CMWA ie• Date: 06/21/99 <br /> Hard copy Printed: <br /> Facility Name : Fac ID: �L <br /> BILL to inventoried FACILITY: <br /> Location: APPDX 1400 WATERLOO (Must have FACILITY IDO) <br /> Complainant : DON GOLDSBY Nome Phone, 209-466-4027 <br /> Address : Work Phone : <br /> STOCKTON CA <br /> FACILITY LOCATION/Property Info - <br /> CBA or Name : _ Loc Code = <br /> Address : 1400 WATERLOO AREA _ _ BOS Dist : <br /> City : STOCKTON APN # = <br /> Phon <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name . _ _ _ . .........Home Phone : <br /> Address= _..... _ _ Work Phone- <br /> City <br /> Nature of Complaint: �f <br /> TACO TRUCK ACROSS FROM CANNER'( IN FRONT OF MIKES POINT LIQUOR . TWO <br /> MEN ATE PORK BURRITOS AND TACO 'S 6-19 -99 ABOUT 10 : 30 ANI . BOTH BECAME <br /> ILL THAT NIGHT WITH DIARRHEA , CRAMPS , HEARTBURN . THEY BEGAIN TO FEEL <br /> BETTER THIS DAY 06-21- 99 . <br /> COMPLAINT Info - <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncii C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> 01-Field Abated 02-Office Abated 03-NA! Sent 04-No to Abate Issued 05-Enforce ACT initiated <br /> 06-Traosfer to Premise File 07-Refer to Other Agency 08 of valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address <br /> Referral L�i.tai �,�nt y : Date, <br /> r7 appropriate Unit N it complaint in another PROGRAM jurisdiction, Have Complaint Record and O'E updated <br /> FOrwardsd to 'i NIT' co III I'± `cr investigation <br />