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' r <br /> t - <br /> Dekt-e run : 11/03/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 � <br /> Run by P KAREN Page 4 1 <br /> copy # 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = 00002877 Program/Element -t*W 13OT,) I <br /> 'ak°n by : 0740 BRUCE ASKANAS Date: 11/03/94 Assigned to 0140 BRUCE ASKANAS Date: 11/03/94 j <br /> Hard copy Printed: <br /> F=acility Dame= Fac ID= <br /> BILL to inventoried FACILITYz <br /> j Location: 2150 FON.TANA.._.. ,s. (Must have FACILITY ID#) <br /> Complainant . BRLIC"E. .A,SKAi�A.S... <br /> ........................... <br /> _..............._................_.........._....._...__...._...__..._...Norrie Phone: 2019-4.68-03;31 j <br /> Address ; ENVIRONM NTAL.---HEALThi., D_IV.I_SION_ Work Phone: 209..-4.6:8-03.31 <br /> FACILITY LOCATION/Property Info <br /> r <br /> DBA or Name: ......... .........._.•...•...... <br /> ........__Loc Code = 99 <br /> ... <br /> ... <br /> -... <br /> ..... <br /> . .... <br /> ............ <br /> . <br /> .....__.. _......._.,........._........... <br /> ... .. <br /> ......._......,.........._........,.......,.._...................._.._....._._..........._.. <br /> Address : 215Q......FONTANA.. .. #3.. BOS Dist. ; 002 t <br /> City : STOCKT0N A P N # <br /> Phone <br /> f <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name . _........._......_.._.............................._...-_......_..._... ......_....._.._..._........._.............__.......__..................._....._._..._...._...__...._Home Phone : I <br /> Address= Wark Phone, 1 <br /> ....._..................._.._...._.._._..........................._......__........... ....----......-.............._............................. <br /> _.. _. <br />! City : <br /> j Nature of Complaint: i <br />+ MONITOR ELEVATED BLOOD LEAD LEVELS t <br /> 1 <br /> 1 " f <br /> i Js <br /> COMPLAINT Info <br /> COMPLAINT MODE: 0 OTHER EH UNIT <br /> f A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Flail/Correspondence <br /> I O-Other EH Unit P-Phone / <. 1 <br /> COMPLAINT STATUS: <br /> j <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 /> i I <br /> i <br /> I <br /> Circle appropfiate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: 10 II II1 1V for Investigation <br /> f <br />