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Da'. � s- uri : 10/'03/9'r SAN OAQUIN COUNTY PUBLIC HEALTH`;tE—FZV'T;C Report 15104 <br /> Run by CAROL.D`, Page # 1 <br /> Copp)#"# ' 01 Of X71 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0009130 Program/Element 1600 <br /> Taken by : Date: 10103/97 Assigned to : 0794 MATHEW Date: 10/03/97 <br /> Hail. copy Printed' <br /> Facility Name = BURGER KING Fac ID : 002725 <br /> BILL to inventoried FACILITY: <br /> Location: 802:s WEST ;_.ANE (Must have FACILITY IDG) <br /> Complainant , TH©N.TFiAi-OY_....PHQ.METH.IFS_.._................._.......... ............_.........._.........Home Phone: 209-952-5619 <br /> Address = 9016 LANDSDOWNE _D ... ._.. .. .........Work Phone : <br /> `arQCKTON CA <br /> . .................... <br /> FACILITY LOCATION/Property Info — <br /> CUBA or Name ' BURGER KING _Loc Code <br /> ... .__. ..................... <br /> Address: 8023 WEST,_._� 1_..._........_..__... BOS Dist <br /> ....................._..............,. ............._..__.... . <br /> CILy STGCKTON 95210 APN # <br /> Phone_- : 209-952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : WYh10_ND..,__-G _l-........ ... ..................... ....................._.. ......................_ ......_......_......_Home Phone: 209-869 -4581 <br /> Address ' PQ......BOX......_380_........_._ ................_.._................_..._... Work Phone: 209--474-7711 <br /> City : RIVERBANK CA 95367 <br /> Natw,-e of Complaint: <br /> ,09-12 -97 AT 7 '30 PM ATE WHOPPER WITH N_O. ©NION AT BURGER KING . BECAME <br /> ILL FEVER , BLOODY DIARRHEA , MUSCLE ACHE ON 09-14-97 AT SAM WAS <br /> HOSPITALIZED AT ST JOSEPH . SALMONELLA --- SONYA ON 09-19-97 . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BO OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> :OMPLAINT STATUS: <br /> 0:-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 05-Transfer to Precise File 07-Refer to Other Agency 08-Nat Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Latter Sent by : Date : <br /> Circle appropriate Unit G if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: 0 II III IV for Investigation <br />