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Date run: 10/05/ 8 AN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 45104 <br /> Nn byS CAROL Page # 1 <br /> Copy # 01 oftoy COMPLAINT INVESTIGATION REPORT <br /> 1 <br /> COMPLAINT # : C0011085 Program/Element = 1625 <br /> Taken by : 7829 GAGAiA Date: 10/05/98 Assigned to 0740 ASXANAS Date: 10/05/98 <br /> Bard Copy Printed: <br /> Facility Name BURGER ;,KI,NG. Fac ID : p02,725. <br /> BILL to inventoried FACILITY: <br /> Location: 8023„.,-..__.WEST._,._EANE. (Must have FACILITY IDI) <br /> Complainant : <br /> <br /> FACILITY LOCATION/Prop6rty Info — <br /> I <br /> DBA or Name: BURGER.__.K.T.Nn' 1­1 Loc Code : O.T.. <br /> Address: 8023 WEST LN BOS Dist <br /> city ”. STOCKTON 9521.0 APN <br /> Phone : 209-952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info Name " WYMOND a....wGI ......._.._._............................................._. Home Phone : 209-869--4581 <br /> ..................................................._..................._... <br /> Address: PO BOX 380Work Phone : 209-474-771.1 <br /> _..._.....-.__...._.-....._........................................._.._..............._........._._................................................_........................ <br /> City: RIVERBANK. C.A. 95367 <br /> Nature of Complaint: <br /> MICE ON FLOOR IN DINING , TRASH AREA AND KITCHEN . FLOORS DIRTY , GARBAGE <br /> FOOD WASTE ON FLOOR . <br /> ,e <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral 8-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: C] <br /> ................. <br /> 3 <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Not Issued 05-Enforce ACT Initiated <br /> 06-Transfer to premise File 07-Refer to Other Agenc 08 09-Foodborne Illness <br /> Send Referral Letterllto: <br /> Address: <br /> Referral Letter Sent 'iby= Date: <br /> Circle appropriate Unit 4 if complaintsin another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I hII III IV for Investigation <br /> I J <br /> 1� <br /> IfY <br />