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Uca .W r x,}11 1 1/ 14 'r,5 HIV J UFlUQ11N UUUN I Y PURL i U HLf;L 11-1 bEHV IU Report # 104 <br /> Run by CAROL !� 'j Page ## 2 <br /> Copy ## = 01 of COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0011272 Program/Element °- 1625 <br /> Taken by : 7829 GAGAIA Date: 11/12/98 Assigned to : 0321 OLIVEIRA Date: 11/12/98 <br /> Hard copy Printed: 11/12/98 .I <br /> Facility Name: DF. L. .TAC0 Fac ID= 007973 <br /> ;s <br /> BILL to inventoried FACILITY: <br /> Location: 678 N WIL..SO.N WAY (Must have,FACILITY ID#) <br /> Complainant: <br /> <br /> <br /> <br /> <br /> F=ACILITY LOCATION/Property Info — <br /> DESA or Name: DEL TACO � Lac Code : . 01 <br /> Address : 678 N WILSON WAY BC35 Dist <br /> City : STOCKTON. 95205 APN # <br /> Phone- 209--941-4307 <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name : SPINCO LLCHome Phone: 209-543-8187 <br /> ... .................................................................................. <br /> Address: 390 PELANDALE AVE Work Phone - <br /> ...................._..._......_........................................................................................................_......._......_........_. <br /> City : M1ODEST.Q. CA. 95356 :a <br /> Nature of Complaint: - <br /> BOUGHT TACO 'S FRIDAY NIGHT ; ALL. FAMILY MEMBERS HAD CRAMPS , VOMITTING , <br /> DIARREHA AND FEVER . DAUGHTER TAKEN TO DAMERON ER DOCTORS REPORT OF <br /> POSSTBLE FOOD POISONING . PLEASE CALL COMPLAINANT . <br /> �i <br /> �i <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-8D 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 " Date : <br /> Circle appropriate Unit 1 if compla' in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> FoNarded to UNIT: I II III IV for Investigation ,I <br /> II <br /> - i <br />