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, . t� I u1,; . 08/18/y'6 _ `-AN JC)AQUIN COUNTY PUBLIC HEAL IH bLRV iU <br /> Page <br /> WDIV+ � <br /> Run by I:ARUL D <br /> # c 1 of L COMPLAINT INVESTIGATION REPORT <br /> >wlNfNfMNlNl1/�1N1NfNl�'11111Nf!'f!'�t'111M.+`!N!!'!full`f1LfNlP1N11'J�`1l�11�4Nf1'fMf�ll`!�!NlNINJNJf"1l �'!V!N!1'd1�l1�11JPfNf19PlNJNl1'JI'111Mf JNINJNf1''d1'!P'11 '71f'1NlNf1VJ1'f <br /> COMPLAINT # = C0010850 Program/Element = t� <br /> 'aker ay : 6519 0I5A Date: 08/18/98 Assigned to 0794 MATHEW Date: 08/18/98 ' /,3 Z 2. <br /> hard COPY Printed V r. <br /> F-a(-ility Name : Fac ID : ,« <br /> BILL to inventoried FACILITY: <br /> Location: 3672 W COUNTRY CLUB (Must have.FACILITY I00) <br /> Comp Ia2.ria rit : SHERIFF 'S OFFIC ...._- .. ....................... Home Phone: <br /> Address ............_......._Work Phone : <br /> STOCKTON CA <br /> FACILITY LOCATION/Property Info — <br /> DBA or NamesLoc Code : <br /> _................. ... .. . ............................................ .-. <br /> Address : 3672 W COUNTRY.._CLUB................... ............_........................................_ ..........._...._E30S Dist : <br /> city- sT-oc T.O.N. ,7) �. APN # Z► -030 - Zr <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name = 1�_+.._5. ... .......'-^'n. 1_�..............._.........-._........ .. .......-............. Phone: <br /> .._.._.....__Home <br /> Address: .d.`t.....IC1�.... _St��EC- o..•,..... t":................................_............-....... ..... 1or k Phone : <br /> T. y, . <br /> Nature of Complaint: <br /> SUBSTANDARD HOUSING . <br /> ►4�1C� j((4.. Q — L <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Prone <br /> Cfli�PLAIN? 5rer��g• b� (�S <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Pof=erral' Letter Sent L;y : _ _ Dater <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to JNIT: II III IV for Investigation <br /> .i <br />