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Pateer n 04/09/93 SAN JOAOUIN COUNTS' PUBLIC HEALTH SERVIC Report #5104 <br /> Run by CAROLD Page # 1 <br /> ef►Y # : 07. of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0012065 Program/Element : 1624 <br /> Taken by : 7829 GAGAZA Date: 04/09/99 Assigned to : 2282 RABACA Date: 04/09/99 <br /> Hard copy Printed: <br /> Facility Name : GHINGGIS KHAN #2 Fac ID : 002460 <br /> ......._.....__....._._ <br /> BILL to inventoried FACILITY: <br /> Location= 6,18 _ _ NWILS.QN WAY #2E (Must have FACILITY ID#) <br /> Complainant : <br /> :. <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name : G.H_INGG.IS KHAN #2„_...._._.,. Loc Code 01 <br /> Address : 678 NWILSON._ WAY 2E BOS Dist <br /> City : STOCKTON 95205 APN # <br /> Phone : 209-466-8899 <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name . SHIN , RONNIE .,_, Home Phone : <br /> Address: 2049 ,_ANGELICO. CR ...,. Work Phone: 209-474-7332 <br /> City : STOCKTONCA 95207 <br /> ........................................ ..._...._ <br /> Nature of Complaint: <br /> FOOD ON FLOOR AND IN TRAYS , FLOORS DIRTY . <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: of <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-PtKie Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency o8 of valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Latter Sent. by: Date : . <br /> Circle appropriate Unit d if compla nt in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I II III IV for Investigation <br />