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E Dote run: 10/13/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 + <br /> Run by : CAROLINE" Page # 2 I <br /> I Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT } <br /> COMPLAINT ## C0002713 Program/Element : 1300 <br /> Taken by : 0740 BRUCE ASKANAS Date: 10/12/94 Assigned to 0740 BRUCE ASKANAS Date: 10/12144 <br /> t <br /> Facility Dame : Fac ID: <br /> BIL! to inventoried FACILITY: <br /> Location= 32_1..._.IU....._CENTUR�'......BLVD .#34„ � (Must have FACILITY IDI) <br /> r � <br /> <br /> <br /> : f <br /> FACILITY LOCATION/Property Info <br /> DBAor Name: ._.............._..__.............._................._................._............_.._.,....,_.....,......... ..._..,..........._..._..._..._........._.__....__... Loc Code : <br /> Address . _.. _...._._..._........_...._,B O S Dist : I <br /> City : APN # <br /> t Phone. <br /> r BILLING RESPONSIBLE PARTY or OWNER Info _ <br /> I <br /> Name '. Home m e Phone : <br /> ..__._............_............._.........._....._._......_...._......_...._......._..._..........................._................................._...._...._..._.............. , <br /> Address: _._......_..._........................._..__.__..............._........._..._.._...................._.........................._...................._...._.....Work Phane <br /> City: <br /> Nature of Complaint: ; <br /> i <br /> r <br /> I <br /> I I <br /> I <br /> I <br /> COMPLAINT Info <br /> I <br /> I COMPLAINT MODE: A AGENCY REFERRAL <br /> { <br /> I A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> I O-Other EM Unit P-Phone <br /> f <br /> I COMPLAINT STATUS: <br /> I <br /> I 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT initiated <br /> I <br /> 05-1ransfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> t , <br /> i <br /> I <br /> I <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 /> 4 i <br />