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Date run: 01./17/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SE:.RVIC Report 45104 <br /> Run by MARYb/0 Page # 6 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0005363 Program/Element : 1600 <br /> Taken by : 0740 BRUCE ASKANAS Date: 01/17/96 Assigned to : 0740 BRUCE ASKANAS , Date: 01/17/96 <br /> Hard copy Printed: <br /> Facility Name: Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location= 1,4000 HWY 88. (Must have FACILITY IDI) <br /> <br /> : <br /> FACILITY LOCATION/Property Info -- <br /> DESA or. Name: JACKPOT.....FOOD,.......:._.. Loc Code <br /> .............................._................_........_._._..__...._._._.__...._...._..._..-----------. .. .. <br /> Address: 14000..._.HWY....._88...._.............._.._.........................._......._._.............__........_........._............._............._.......................__...........,........_EGOS Dist <br /> city = APN # : <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> a Name: Home Phone: <br /> Address: Work Phone: <br /> ti City : <br /> Nature of Complaint: <br /> FIRE AT FACILITY <br /> URGENT <br /> COMPLAINT Info — <br /> COMPLAINT MODE: 0 OTHER EH UNIT <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPS TUS: <br /> 01-Field Abat 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued OS-Enforce ACT Initiated <br /> er to Premise File 07-Refer to Other Agency OB-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> Forwarded to UNIT: II III ' IV for Investigation <br />