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.x &�Ge run: uj/utsiy� SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Revort 15104 <br /> CAROLD page <br /> z„Cam # 01 of OI COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0011850 Program/Element = 4200 <br /> Taken by 1699 YOAKUM Date: 03/05/99 Assigned to 1699 YOAKUM Date: 03/08/99 <br /> Hard copy Printed` <br /> Facility Name Fac ID : <br /> BILL to: inventoried FACILITY: <br /> Location: 2774 E RD (Must have FACILITY ID#) <br /> 77 <br /> pomp 1 a i na nt : El .MER Home Phone.: <br /> Address . 2 BYRON RD Work Phone : <br /> TRACY CA <br /> FACILITY LOCATION/Property Info <br /> DBA or Nam-: v. • ,Loc Code <br /> -- ......... .. ...--- - - .... <br /> Address : 2 ... <br /> 774 -W- BR ...... <br /> YRON .. _..................................BGS Dist <br /> city- TRACY APN # <br /> Phone : ; <br /> BILLING RESPONSIBkE PARTY or OWNER Info <br /> Name DBFritT &0 (AlUTnXvl.5 Home Phone : <br /> Address: < - �. <br /> �'$ ��►'� �►!NDr�..�90� ro <br /> ....... ..... <br /> ..... . .... _.... . .... .-._Work Pne: <br /> CiitY '. ILlc�r.��vp , #41t#rA) <br /> Nature of Complaint <br /> SEPTIC FAILURES . <br /> d <br /> .y <br /> COMPLAINT Info <br /> COMPLAINT MODE: P PHONE <br /> A-A¢enCY Referral B-BD OF Supervisors/City Ccouhcil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> ' .I <br /> COMPLAINT STATUS: O r <br /> eld Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT•,;Initiated <br /> 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: I II III IV for Investigation <br />