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r� <br /> Date run " 03/30/4 N JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Rur* by ^ : CAROL Paae # 1 <br /> Copy # � Dl ofT. - COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0009953 Proqram/Element <br /> Taken by : 6519 DISA Date: 03/30/98 Assiqned to 0794 MA+MM Date: 03/30/98 <br /> Hord onv, Printed: <br /> Facility Name : BURGFR KTN8 Fac TD ' 002775 <br /> BILL to inventoried FACILITY: <br /> Location: 902-� WESTLANE (Must have FACILITY 0O) <br /> Complainant: <br /> : <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name : BUR�E9--t(IN8-...........................................__-'__---____-__'___-__----_Loo Code : 01 <br /> Address* 8O23__W��T_LN�___� _ _ ______ __ ___ B0S Dist : <br /> City : 5TO�KTON 95210 APN # � <br /> Phone : 209-952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name : WYM0MD , GIi -- --' --_ -1Home Phone : 209-869-4581 <br /> Address. pD_B8XWork Phone : 209-474-7711 <br /> City: RIVERBANK CA 95367 <br /> Nature of Complaint: <br /> MICE DROPPINGS BEHIND SODA MACHINE . <br /> COMPLAINT Info - <br /> COMPLAINT MOO[: P PHONE <br /> A-Agency Referral R-80 OF Super viuvro/Citv Covonci\ C'Cvontn, M-Mai}/Co,/oopondwoov <br /> O-Other FH Unit P-Phone <br /> COMPLAINT STATUS: ~°~ <br /> Abated 02-Offiop Abated 03-NAI Sent 04-Notice to Abate lnaood 05-Enforce ACT Initiated <br /> or to Premisei 07'Rofor to Other AVonoyv'- V8'Not Valid 09-Foodborne Illness <br />`--06 Tr'�en«d Referral Letter to: <br /> Address: <br /> Referral Letter Sent by ; _ _ _ _ _ _ Date" _______ <br /> Circle ammorioLv Unit 0 if omm\oint in another PROGRAM Jurisdiction, Have Complaint 8ocv/d and P/[ updated <br /> Forwarded to UNIT:0 TT DI IV for Investigation <br />