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Date run: 09/16/98, _.5AN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by CAROLD I(U Page # 2 <br /> Campy: w 01 of 01W COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : C0010993 Program/Element 1322 <br /> Taken by : 5366 LINEBAUGH Date: 09/15/98 Assigned to 5366 LINEBAUGH Date: 09/15/98 <br /> Hard copy Printed, <br /> Facility Name: Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: 3672_,._W.__COUNTRY,,,,,,CLUB. (dust have FACILITY I0#) <br /> Complainant: <br /> <br /> <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : Loc Code : <br /> Address : 3672.--W_._COUNTRY.._.,CLUB...._...-._......_.._..................._. _BOS Dist : <br /> City: STOC T . APN # <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : <br /> <br /> <br /> <br /> Nature of Complaint: <br /> STRUCTURE SFD SUBSTANDARD , PARTIALLY CONSTRUCTED AND UNSECURED , POSTED <br /> AS SUBSTANDARD . <br /> COMPLAINT Info — <br /> COMPLAINT NODE: PPHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: 5 <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-Hat 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 />