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Date run : 04/29/ SAN JOADUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Lin b, : CAROLDLI Page <br /> e <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0012159 Program/Element, 1625 <br /> Taken by : 6519 DISA Date: 04/29/99 Assigned to 0740 49"" Date: 04/29/99 <br /> Hard copy Printed: _04-Aw-A tf <br /> Facility Name : BURGER KING Fac, ID : 002725 <br /> BILL to inventoried FACILITY: <br /> Location; 002 WEST LANE, (Must have FACILITY ID#) <br /> Compiai.11ant ' k0bi- PI SERONELLO Home Phone : 209-786-2858 <br /> Address : Work Phone : <br /> FACILITY LOCATION/Property Info <br /> DBA of Name : BURGER KING Loc Code : 01 <br /> Address :ess 8023 WEST LN BOS Dist : <br /> City : STOCKTON 95210 APN # <br /> Phone : 209 -952-6595 <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> — <br /> Name ' WYMOND , GIL Home Phone : 209-869,-4581 <br /> "Iddress : PO BOX 380 Work Phone : 209-474-7711 <br /> City RIVERBANK CA 95367 <br /> Complaint <br /> C <br /> Natu,e of <br /> AfE CHICKEN SANDWICH ABOUT 6 : 30 PM 4-28-99 BECAME ILL ABOUT 12 : 00 AM <br /> VOMITING AND DIARREHA . <br /> COMPLAINT Info <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/CoTrespoodence <br /> 0-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 Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by : Date : <br /> Circle appropriate Unit 0 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P,1E updated <br /> Forwarded to UNIT:0, Il III IV for Investigation <br />