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HEALTH SERV-r(- Report #5104 <br /> kw L, C-rip u;'. _ � �t� Page tt 2 <br /> _OMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0008984 Program/Element 2547 <br /> Aar 0997 KNOi__ Gate, 09!15%9? Assigned to 0997 KNOLL Date: 09/15/97 <br /> Hard t c,a- <br /> FW.ci .1Lty Name Fac ID : <br /> BILL to inventoried FACILITY: <br /> Location= 31(, 1.J _ CHAPTFuI= 1,1r T 0� F;:T0N (Must have FACILITY ID#) <br /> _ . ..__.:..... ....... ....... <br /> C0111piairlalit CITY FIRE CAPTAIN ALLAN Home Phone? 209--937-802I <br /> Address : VIA S .J . GEN RENEE Work Phone = <br /> FACILITY LOCATION/Property Info — <br /> I-:BA I)r NaIII Lac Cude : <br /> .. : BOS Dist <br /> APN tk = <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Ndm - Home Phone 7 <br /> ,Jor k Phone <br /> C' f f.„ <br /> DIE'E•EL SP i'__L_ -REPUF:TED . NO EHD RESPONSE REQUESTED . ABATE H .I<NOLL . <br /> COMPLAINT Info — <br /> :?.PLAINT MODE: -'HONE <br /> 4-Rae r:r Rp_fer-al 8-8D OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> .^M01-ATNT STATUS: <br /> 01-Field Abated Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 0�-Transfer t^ Premise Fiie 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address <br /> ' t al L Lt,eT e h _ Date= ---- — _ <br /> aacropriate !'nit 0 if complaint in another PROGRAM .jurisdiction. Have Complaint Record and P/E updated <br /> IV f^r Investigation <br />