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Date run ; 08/15/94 SAN JOAQU I N COUNTY PUBLIC HEALTH SERV I C Report #5104 <br /> Run *by CAROLINE Page # 14 <br /> Copy, o 01- of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0002416 Program/Element : 4200 <br /> Taken by : 0794 RRJU MATHEW Irate: @8/12/94 Assigned to : 0794 RAJU MATHEM Date: @8/12/94 <br /> Facility Name : JACKS PLACE Fate I D; 003221 <br /> BILL to inventoried FACILITY: <br /> Location: 7939 W 11TH ST (Must have FACILITY ID#) <br /> Complainant : <br /> : <br /> FACILITY LOCATION/Property Info - <br /> DPA or Name : JACK' S PLACE Loc Code 03 <br /> Address : 7939 W 11TH_ STREET — ---_--�--PCIS Dist 00 <br /> - <br /> City : TRACY APN # a _� <br /> Phone : 209-832-3399 <br /> BILLING RESPONSIBLE PARTY or OWNER Info Name: JACK GU_EY MAH Home phone: <br /> Address: 7939 W 11TH STREET Work phone : 209-688-0949 <br /> City : TRACY CA <br /> Nature of Complaint: <br /> SURFACING SEWAGE BEHIND JACK' S PLACE AND HOLLAND CENTER <br /> COMPLAINT Info -- <br /> COMPLAINT MODE: ire ' PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncii C-Counter M-Mai I/Correspondence <br /> O-Other EH Unit ' P-Phone <br /> COMPLAINT STATUS: OC <br /> A?lField Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> Transfer to Premise File 07-Refer to Other Agency 08-Not_ Val,id 09-Foodborne Illness <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Coaplaint Record and P/E updated <br /> Forwarded to UNIT: I II III IV for Investigation <br />