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SAN 7OAQUIN COUNTY PUBLIC HEALTH SER' o /T 30 <br /> ;an 1�'Y : DENORA <br /> Copy # 01 of 01C9M'PLAINT INVEiSTIOp'TION REPORT aye # 1 <br /> COMPLAINT # COO11979 Program/Element: 4200 <br /> Ta Ken by : 7829 GAGAZA Date: 03/25/99 Assigned to 1699 YOAKUM Date: 03/25/99 <br /> Hard copy Printed: 0L <br /> Facility Name✓ JACKS PLACE_ Fac ID : 003221 <br /> BILL to inventoried FACILITY: <br /> Location: 7939 W 11TH ST (Must have FACILITY IO#) <br /> Complainant : <br /> <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : JACKS PLACE . . , Loc Code : 03 <br /> Address : 7939 W 11TH ST BOS Dist : 005 <br /> ............ <br /> City : TRACY 95376 APN # : <br /> Phone : 209-832-3392 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name . MAH , GUEY. JACK, Home Phone: -334a <br /> Address: 31., E GRANT LINE RD_ Work Phone : 209—ter <br /> City : TRACY CA 95376 <br /> Nature of Complaint: <br /> SEWAGE LINE BROKE AND RAW SEWAGE IS GUSHING ON TO THE GROUND BEHIND <br /> THE RESTAURANT <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-Phone <br /> COMPLAINT STATUS: 0/ <br /> 1 �AbatedOffice Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> e File 07-Refer to Other Agency 08-Not 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 />