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Date run: 02/26/ 8 AN OAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by CAROL Page # 1 <br /> Copy # = 01 of 0 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0009744 Program/Element : '3,60t <br /> Taken by : 6519 DISA Date: 02/25/98 Assigned to : 0843 COLLINS Date: 02/26/98 1 i <br /> Hard copy Printed: <br /> Facility Name : FOOD 4 LESS Fac ID : 002463 <br /> BILL to inventoried FACILITY: <br /> Location: 673 N._,._W.I_LSON.._WAY (Must have FACILITY ID#) <br /> Complainant : <br /> <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DBAor Name: F00D._._4...._LESS._......................................_.................................................... ......Loc Code : 01. <br /> Address: 678_..._N._.._WILSO ._. <br /> NWAY._.....__.........__ _ _ <br /> _...........,_. .......BOS Dist : <br /> City: STOCKTON, 95205 APN # <br /> Phone: 209-466-2751 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : PAG INC Home Phone : 209--478-9314 <br /> Address: 334.1._....._.WILLOWBROOK..,._CR....._._......................._......._......_..__....._.....__.....__.............Wor- k Phone : 209-957-4917 <br /> City : STOCKTON C. 95219 <br /> Nature of Complaint: <br /> BOUGHT CHICKEN . FOUND WHAT LOOKS LIKE WORMS . <br /> j2 7_ otei <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <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 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 : _ __ __ r__ Date: <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I� II III IV for Investigation <br />