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`"tae ru` SAN JOAQUIN COUNTY PUB IC HEALTH SERVIG Report 15104 <br /> Run by It L) Page <br /> Page # 1 <br /> Copy, IP of 0 COMPLAINT INVESTIGATION REPORT <br /> MMMMMMMN1lNlMMMNfNfMMMNfN1MNfNfNIMMMMMNIMMMNfNFNIN1hfNfMNJNJMMf'1NlNJNf!IMMMNJMMNIMNIN{MN{MNIMMMMNIM!'fNIMNIP'1NlMMNf <br /> COMPLAINT # = C0011106 Program/Element 1625 <br /> Taken by : 7829 GAGAIA Date: 10/08/98 Assigned to : 0740 ASKANAS Date: 10/08/98 <br /> Hard copy Printed: <br /> Facility Name: BURGER KING Fac ID : 002725 <br /> BILL to inventoried FACILITY: <br /> Location: 8023 WEST LANE (Must have FACILITY IDI) <br /> :i <br /> Complainant : CARLOS_..._A_QUILAR .. .Home Phone: 209-952-1714 <br /> .._.._............_.._.._............................_... ..._....... <br /> Address : Work Phone- , <br /> a <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name= BURGER. KING Loc Code : 01. <br /> Address: 8023 WEST LN BOS Dist : <br /> .... <br /> . -. ...........__..._.............._................_..................._..............._......_.........._.._......................._.............................._._.............._..................._....._......._. <br /> City. STOCKTON. 95210 APN # : <br /> Phone : 209-952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name : WYMOND.,.._ -M....._...._.._..._._....._............._......................... .-..._....__..........,._.........._....................-.......Home Phone : 209--869-4581 <br /> Address: P0-__E30X__..580._...__..___._... Work Phone: 209--474-7711 <br /> City : R V RBANK. CA 95367 + <br /> Nature of Complaint: a <br /> ATE BREAKFAST THIS., AM . COOKS USING DIRTY GLOVES , COOK CHANGES* GARBAGE <br /> AND PICKED UP GARBAGE ON FLOOR , ALSO USING REGISTER WITHOUT CHANGING „ <br /> GLOVES . SODA DISPENSER WAS ALSO DIRTY . <br /> a <br /> COMPLAINT Info -- <br /> COMPLAINT MODE: P,_......PHONE <br /> r <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: <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Pre er to Other Agency 08-Not Valid 09-Foodborne Illness <br /> ' r � <br /> Send Referral Letterlto: <br /> Address: <br /> Referral Letter Sent ' by : Date : <br /> Circle appropriate Unit 0 if complaiW in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I i11 III IV for Investigation a <br /> I <br />