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Date run: 11/08/99 SANK J�OAQUIN COUNTY PUBLIC HEALTH SERVIC Report 15104 <br /> Run by D.HNORA Page # 3 <br /> Cop 01 of Ol`4 COMPLAINT INVESTIGATION REPORT <br /> �llrIMMMMMMMMMMMMMMI►fMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM1�iMMMMMM <br /> COMPLADW dh C0013253 Program/Element 4200 <br /> Taken by : 1644 TOAIUN Date: 11/05199 Issi.gned to : 1699 YO1CU1 Date: 11105/99 <br /> Hard copy Printed: <br /> facility Name : _ Fac ID: <br /> ;)WO PILI, to inventoried FACILITY: <br /> Location: � BYRON RD (must have FICILITY I11) <br /> Complainant : <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : _ -- -- Lee Code : <br /> Address : BOS Dist : <br /> City: APN fk <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : Home Phone: <br /> Address : Work Phone : <br /> City: — <br /> Nttire of Complaint: <br /> SURFACING SEWAGE <br /> COMPLAINT Info <br /> CONPLUIT 1091: <br /> 1-Agency Referral 1-PD OF Saper►isors/City Cconncil C-Coueter I-bail/Correapoodeace <br /> O-Other 1H Unit P-Fbone <br /> CONPLAIIT STATUS: d2—Z <br /> 01-Field Abated 02-Office (bated 03-NAI Seat 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> O6-Treesfer to Premise File 01-Refer to Other Igeacy 08-Not Valid 09-Foodborne Illneas <br /> Send Referral Letter to: <br /> Address : <br /> Referral Letter Sent by: Date : <br /> Circle appropriate Unit i if complaint is a4otber FROCRIN jurisdiction, lave Complaint Record.and P/1 updated <br /> Forwarded to UNIT: I II III IV for Investigation <br />