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<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ^ u .... Phone . <br /> Complainant ...._._....... ..........._.. <br /> Address= .. ...._......... <br /> ..Loo Coda D1_ <br /> FACILITY LOGATION1ProPerty info <br /> ...............................__.._..........._......_...._._....._........._....._........_..............._......_........_......... ..... <br /> 845 Dist <br /> DBA or Name" . .......................__.._....... APN <br /> Address', S,O23..._W ST....._�_......._.._....._......_..........._....._.... .: ... .. <br /> city " 5 f 0_C!{_T ?-N_ 95210 . <br /> phone: 209--952-6595 <br /> Home Phone: 209-869-458 . <br /> BILLING RESPON YMONDPA IL-....._ r.. -OWNER Info....:.................................__._...................... 2Q9-�474-7721 <br /> Name <br /> Work Phone" <br /> DX 38 ......... <br /> Address: Pn .13 95367 <br /> City = RIVERROW. CA. <br /> Nature of Complaint <br /> 21/18/99 11 ° 80 A <br /> RAW - DID NOT EAT THE HAMBURGER <br /> COMPLAINT Info <br /> COMPLAINT MODE P,..,_..__PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncii C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS! g <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-No O$- of Valid bate Issued 4-Foodborne Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency <br /> Send Referral Letter to: <br /> Address= <br /> Referral. Letter Sent by : �- _ .. Date <br /> Circle appropriate Unit A if COMP6 <br /> t inanother PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNII III IV for-Investigation <br />