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Date run: 04/22/98 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC paorrt01#04 1 <br /> Ruri by CAROLD(j <br /> Copy # 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0010097 Program/Element = tf506 J(v <br /> Taken by : 6519 DISA Date: 04/22/98 Assigned to : 0843 COLLINS Date: 04/02/98 <br /> Hard copy Printed: <br /> Facility Name: Fac Fac ID: 002462. <br /> BILL to inventoried FACILITY: <br /> Location: 678,_,_.._..._.._N...._WILSON...-.WAY (Must have FACILITY I00) <br /> Complainant: <br /> <br /> <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name; EL_„POLLO,_,.,LOCO.„.,#5893._....._..__..._............._.__.__._..._..........._.-.._........................,..........___......_._.._......_._Loc Code 0.1„ <br /> Address: 678._.._N_.._WZLSQN.._._WA '................................_._._....__........._......_....._............__....__._..._._._......- SOS Dist = 00.1.. <br /> City: ST0CK70N 95205 APN # <br /> Phone: 209--942-21.44 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: ARMENTA_,.......R...A,FAEL_..._&......BERTHA......................................._._......_.....................__ <br /> Phone : 209-545-2943 <br /> Address: 3429GAGOSTAN._._OT...._..._._......_._-...................................................................._._......_.-.__._..work Phone: 209--951-4761 <br /> City= 60DE51 C.A. 95356 <br /> Nature of Complaint: <br /> ATE CHICKEN BURRITO ABOUT 12:00 PM . BECAME ILL 8:00 PM VERY BAD <br /> VOMITING AND DIARRHEA . <br /> .,?l9rlctt= 414— <br /> COMPLAINT Info <br /> — <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 /> Ob-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 # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: II III IV for Investigation <br />