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Date run: 09/24/98 SAN�QUIN COUNTY PUBLIC HEALTH SERV IC Report 05104 <br /> �� <br /> Run by : CAROLD Page , # 1 <br /> pp+y # 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0011042 Program/Element 1625 <br /> Taken by : 1829 GAGAZA Date: 09/24/98 Assigned to : 0140 ASKANAS Date: 09/24/98 <br /> Hard copy printed: <br /> Facility Name : BU _ _ .. . <br /> RGER,..__K_z_NC Fac ID: 002725, <br /> BILL to inventoried FACILITY: <br /> Location: 8023 W ............ <br /> Complainant : REBECCA..................................................................._...._..................._.....................................................__Home Phone : 209-465-2575 <br /> Address : _Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: BURGEF2....._K.Z_NG...... <br /> ............. <br /> ................... <br /> .................. ......_............... <br /> ....... <br /> ............Loc Code : 01. <br /> Address: 8©23....._WEST....._EN....__........................_._........................ _. _._...._.......................__BOS Dist : <br /> City: STOCKTON. 95210 APN # <br /> Phone : 209-952- 6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name " WYMOND..x.......0.I_L-._... <br /> ... <br /> ... <br /> .........................................._._. ...... ..... <br /> ...... <br /> _ <br /> .... <br /> _Home Phone : 209-869-4581 <br /> Address: PO......BOX...._38Q._....................................._............................................................................_..._..............._................Work Phone ' 209-474-7711 <br /> City: RIVERBANK. CA 95367 k <br /> Nature of Complaint: <br /> ATE HAMBURGER , BECAME ILL . CRAMPS , DIARREHA . WENT TO !DOCTOR . HAD TEST <br /> TO VERIFIY FOOD POISIONING . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: 6 <br /> 01-field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enf0rce ACT Initiated <br /> 06-Transfer to Premise File 01-Refer to Other Agency -Not a i 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: / I) IT III IV for Investigation <br /> ;e � <br />