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Date *-un: 05/13/9 S N JOAQUIN 'COUNTY PUBLIC HEALTH SERVIC Report 15104 <br /> R�n " CAROL[/ I� Page # 1 <br /> Py : 01 of I COMPLAIN INVESTIGATION REPORT <br /> COMPLAINT # = C0010241 ,` Program/Element —•- <br /> Taken by : 0008 BRIGGS Date: 05/13/98 i Assigned to 0008 BRIGGS Date: 05/13/98 <br /> Hard copy Printed: 05/13/98 <br /> Facility Name : .......... Fac ID " � <br /> BILL to inventoried FACILITY: <br /> Location: S..........OF.....SEA_I_N._..S.T...-. .ON....._J.AGKT©N......RD (Must have FACILITY I0�3 <br /> ;, <br /> Complainant : <br /> <br /> <br /> FACILITY LOCATION/Property Info <br /> DBA or Name: .. . .................._......_.�.............,.......... Loc Code - <br /> Address : ST.........._ON,E_.JACK,TONE......Ra........_....._..... .. BOS Dist : <br /> .............._...................Y <br /> City: 'M APN # <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info -- <br /> Name : .�....._.............. Home Phone: <br /> Address: Work Phone : <br /> City : ....... <br /> Nature of Complaint: iM <br /> POSSIBLE DISPOSAL OF USED OIL INTO CANAL IN BACK OF AN ORCHARD . <br /> I <br /> II <br /> COMPLAINT Info — <br /> i <br /> COMPLAINT MODE: P....,.......PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: I <br /> (Z)Field Abated 02-Office Abated 03-NAI Sent 1104-Notice to Abate Issued 05-Enforce ACT Initiated <br /> Ob-Transfer to Premise File 47-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: �E <br /> Address: <br /> Referral Letter Sent by : Date: <br /> Circle appropriate Unit I if complaint in another PROGRhM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I IIIII IV for Investigation <br /> I` <br /> i�� <br />