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C -IO^;Ol,T rniUNITY nt Fie L it ! rFR',, r Report 1!5104 <br /> ,t,sr� spy i�fARYC�� <br /> ropy # c� �C � COMPLAINT TiV'JEST"TC�ATTC�I� Rs=F0�?T Page #f 1 <br /> COMPLAINT # = C0O03965 Program/Element I60 <br /> 0 <br /> Talen by : 9051 MARY OSULLIVAN Cate= 06/01/95 Assigned to 0794 RA U�",,;mEW Cate- 06101/45 <br /> Hard copy Pri^tecd: <br /> Fac",].:I its Name : Fac ID ' M,1 <br /> 8ILL to inventoried FACILITY: <br /> Location- 013i L.ANElF{AI f�E`R (Must have FACILITY I0#) <br /> Comp l a 3-na nt = <br /> <br /> FACILITY LOCATION/Prope?rty. Info <br /> DESA or Name: BUGGER KING L.oc Code <br /> Address : 8023_. 'WE T _1-ANE/HAMMER <br /> _ ... .. .. 80 Dist <br /> City APN if <br /> Pho1-1e = <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Addre^5� : - Work Phona, <br /> .................. ........... .. ..._. . . .. ...._ <br /> city * <br /> Nature cf Coulaint: <br /> AT BURGER KING , CHILD TOOK A FEW BITES OF A HAMBURGER , WFITCH <br /> THE MFAT WAS RAW - THEY DTD RECEIVE A REFUND , BUT CHILD NEEDED TO BE <br /> TAKEN TO DOCTORS HAVE TALKED TO LAWYER <br /> COMPLAINT Info — <br /> CRPLAINT 401DE: P PHO'JF <br /> A-Agency Referrai B-BC OF Supervisor,/Cty Ccouncil C-Courter M-Mail�Correspondenr.e <br /> 0-0ther EH Unit P-Phone <br /> C^MPLAINT STATUS- &K <br /> C1-Field-Abated 02-Office Abated 03-NAI Sent 04-Not- e to Abate Issued 05-Enforce ACT Initiated <br /> 0b-'ransfer to Premise File 07-Refer to Other Agency 0E "I5t Valid 09-Foodbor a ,!loess <br /> CiTcle ar,vc,-r:.at? Unit 0 if u7pla�71,t ir another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: ' ] II ili IV for Investip t:ofi <br />