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Date run: 10/25/98 __5AN JOAQUIN COUNTY PUBLIC HEALTH SERVIC KepoTtea�u4 1 <br /> Run by � CAROLD <br /> Copy #- ',: 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : 00011190 urogram/Element = 1625 <br /> Taken by : 7829 GAGAIA Date: 10/26/98 Assigned to : 0740 ASKANAS Date: 10/27/96 <br /> Hard copy Printed: <br /> Facility Name: E3URGER..KING Fac ID 002725 <br /> BILL to inventoried FACILITY: <br /> Location: 8023 WEST LANE (Must have FACILITY ID#) <br /> Complainant= <br /> , <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: BURGER. _K_I_NG.....__-:......._.._..._. hoc Code <br /> Address : 8023_- WEST....LN.................. _BOS Dist <br /> City: STOGKT"oN. 95210 APN # <br /> Phone: 209-952-6595 <br /> I, <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name- ..........Home Phone : 209---869-4581 <br /> WYMO_... ..__G. <br /> ..................... <br /> ....._......._.......... <br /> Address' PQ, B0.x..._...38b........... ......... -Wor k Phone: 209-474-77'11 <br /> City „ R,I.VBRBANK. CA 95367 <br /> Nature of Complaint: <br /> DEAD SPIDERS IN SOBA CUPS , SEVERAL CUPS HAD SPIDERS IN THEM . <br /> 3 � <br /> ,t <br /> COMPLAINT Info — ? <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-8D OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> a <br /> COMPLAINT STATUS: <br /> 01-Field Abated 02-Office Abated 03-NRI Sent 04-No ' ued OS-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agenc O8-Not Valid 9-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Dater . <br /> Circle appropriate Unit K if comp in another PROGRAM jurisdiction, Have Complaint Record and P1E updated <br /> Forwarded to UNIT: I Ii III IV for Investigation <br />