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Date run= 04/29/,9�6/�,,SAN JOAOUIN COUNTY PUBLIC HEALTH SERVIC Report #51104age <br /> 5 <br /> J U <br /> I Run by � MARYO C <br /> Copy # Q1 of 01 COMPLAINT, INVESTIGATION REPORT <br /> a <br /> COMPLAINT # = 00005973 Program/Element = 1600 <br /> Taken by . 9051 MARY OSULLIVAN Date'.. 04/29/96 Assigned to : 0626 HECTOR CASTRO Date: 04129/96 <br /> Hard copy Printed: <br /> Facility Name : 8URGR...._K,I_NG. Fac ID: fl0.2725 <br /> BILL to inventoried FACILITY <br /> Location: 8023.....__.W S.T„.,_LANE•~. (Must have FACILITY ID#) <br /> Complainant: [ BB_I. ..............._........ ..... Home Phone : 209-951-8316 <br /> Address : ...............................Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : BURGER KING Loc Code 01. <br /> ... <br /> Address= 8023........W�ST LAN_ ...._...._. ...._:.: .._.... _._..._. ...... . ..... <br /> BOS Dist <br /> City- S "OCKTDN. 95210 <br /> APN # <br /> Phone : 209-952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : WYM.ON.O...>.......G_I_L.............--...,.....................,..................._....................__.................I........._-_:....................:..._Home Phone = 209-8b9-4581 <br /> Address: PO BOX 38d....... ................ Work Phone: <br /> 1 <br /> City , R_I,VERBANK. C.A, 95367 <br /> Nature of Complaint: <br /> 12PM ON THE 4/29/96 SHE WAS AT THE ABOVE FACILILTY WHEN SHE NOTICE <br /> ROACHES RUNNING AROUND , THE PLACE WAS VERY , VERY , DIRTY . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City CCRUnCil C-Counter M-Hail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS, . <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise file 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit A if complaint in another PROGRAM jurisdiction, Have COmplaiRt Record and P/E updated <br /> Forwarded to UNIT: III IV for Investigation <br />