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SAN J'OAQU IN COUNTY PUBLIC HEALTH SERV IC Report 15104 <br /> Rug by : DENORA .j Page # 3 <br /> Copy it = 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0011416 Program/Element : r� <br /> 'aken av , 7824 GAGAIA Date: 12/21/p8 Assigned to 5366 LINEBAUGH Date: 12121/98 <br /> HaA copy Pripted• <br /> Fac.:i 1 i t;y Name " Bt�RGE R,..KING Fac ID : 0027,25. <br /> " BIL3 to inventoried FACILITY: <br /> Location: WEST _ ..ANE (Mint have FACILITY I00 ) <br /> complainant : SHELLY PRATER Home Phone : 209466--4321 <br /> Addy ew=s : or k Pho <br /> I <br /> a <br /> FACILITY LOCATION/Property Info — <br /> DBAor Name : BURGER- - .._........._..----....._....._........................_....._.._.....__......._............__........... " ...:,;. Loc Code = 0_l:. <br /> Addy ess= 8023_._WEwST....._LN..........................._........_._....._....._......._........ ....... .......... _605 Dist <br /> City - STOCKTON 95210 APN # <br /> Phone- 209-952---6595 j <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name : WYIM NQ.,...G_I.L._... ............................_ ._...... .._. Name Phone : 209-869-4581 <br /> Addre:--s: Pb .BOX _38.0._. ...._......._........... ..._......... _..... .._._....... ...._......_..... .__.._.. Work Phone : 209-474-7711 <br /> City - RIVERBANK CA 95367 <br /> l <br /> Nature of CoRplaint; � <br /> FEST FILTHY . BACON SITTING ON TOP OF BOXES AND FRENCH FRIES , GREASE <br /> ON FL-OORS , EMPLOYEES NOT USING GLOVES N <br /> 't <br /> .a <br /> COMPLAINT Info - <br /> tOMPLAINT MODE: PHONE <br /> _ IJ <br /> j <br /> A-Auency Referral 9-90 OF 5upervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: !� <br /> 01-F7.eld Abated 02-Office Abated 03-NAI Sent 04-Notiat to Abate Issued 05-Enforce 'CT Initiated <br /> 06-Transfer to Prnise File 07-Refer to Other Agency 08- ,ot Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address= <br /> Referr-& 1 Letter Seat by: - Date: -,,.— _. <br /> Ci�c.e appropriate Una! # if complaint in another PROGRAM jurisdiction. Have Complaint Record apd P/E updated <br /> Forwarded to JNIi. I II III IV for Investigation <br />