HomeMy WebLinkAboutEH-02-2016-5904.TIF g C0 CATAWBA COUNTY ENVIRONMENTAL HEALTH
d N ENVIRONMENTAL HEALTH COMPLAINT FORM ***CONFIDENTIAL***
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FOOD SERVICE COMPLAINT
Complainant JERRY KAYLOR, 421 5TH ST NW, HICKORY NC 28601
C:8283812925
Violator PDQ, 2060 HWY 70 SE, HICKORY NC 28602
SANITARIAN: Greg Kain
PROPERTY ID#: 371107697286 STATUS : Active CALLBACK: YES
MEDICAL CONFIDENTIAL: YES
STREET ADDRESS: 2060 HWY 70 SE, HICKORY NC 28602
DIRECTIONS: PDQ
Food Service Complaint
Food Service Complaint COMPLAINT: 9 VIOLATIONS:
VIOLATION DESC: Complaint form completed in Office:
"PDQ-2/14/16 at 7:30 pm
Grilled Chicken Salad-2 Persons-Jerry&Trish - Drinks 2 Lemonaide-grilled chicken, lettuce, almond,
guacanole,raisins, cherry tomatoes, cranberrys
time sickness started-7:30 pm Feb. 14,2016 - Sunday evening Started throwing up&vomiting myself&
grit friend -had to go to the Dr. Morgantee Family Practice Associates Viewmont . Food contamination-
nasua- heavy pains in stomach could not stop vomiting"
DUEDATE VIOLATION DATE ENDDATE
DATE RECEIVED: 02/19/2016 PRELIMINARY DATE: CLOSED DATE:
EXTENSION DATE:
ACTIVITY DATE NAME COMMENTS
INSPECTION# STATUS TYPE COMPLETED
rehcomplaintform 02/19/2016 10:03 Page I of 1
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**For Office Use Only**
Date and Time Received �/Xil/, 10/ 20 /‘
Received By //1 J te AL... %l
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