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� <br /> Date run: 03/02/95 SAN JOAQUIN COUNTY PUBLIC HEALTH SEPVIC Report 45104 � <br /> Rum by : SHELLY � <br /> � ~o^ Page 13 <br /> COPY # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT C0003417 Program/Element : 1600 <br /> Taken by -. 0794 RAJU MATHEW Date: 03/02/95 Assigned to : 0794 Date: 03/02195 <br /> Hard copy Printed: U3 <br /> Facility Name: Fan Z0: <br /> BILL to inventoried FACILITY: <br /> Location: <br /> P W� (Must have FACILITY 0O) ----- <br /> Complainant' ______Homo Phone : <br /> Address - <br /> . _Work Phone: <br /> _ <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name� c Code : 01 <br /> Address � S Dist � <br /> City: _ APN # : <br /> Phone - <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : Home Phone : <br /> _---- ----- __ <br /> Address Work Phone : <br /> City : <br /> Nature of Complaint: ' <br /> OPERATING MFPU WITHOUT A COMMISS6 RY <br /> COMPLAINT Info <br /> COMPLAINT MODE: pPK0NE <br /> A-Agency Referral 8'B8 bF.Supomimom/City Coounxil C-Countwr M-Hail/Cormopondonoo <br /> / 0-Other EH Unit P'Phnna <br /> COMPLAINT STATUS: <br /> O1-Fin]dAbated 02-Office Abated 03-NAI Sept84 to Abate ImnuoU OS-[nfomo ACT Initiated <br /> 07-Refer to Premise File 07'Ko� to Other Agency /~OD�ot valid 09'Fuo hmno Illness <br /> `��' <br /> Cbdo appmpriato Unit # if complaint in another PROGRAM j�nindivtion. Have Complaint Hnw/d and P/E updated <br /> /`� <br /> Forwarded W UNIT: ( [� II III IV for Investigation . <br /> ' ` <br />