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IN -, UWI\ I i Ruo .by CAROLDf Page # 2 01 of �I COMPLAINT INVESTIGATION REPORT COMPLAINT #�- COOO9O3O Program/Element : 4200 ',aAen by 3304 ARMSTRONG Date: 09/19/91 Assigned to : 4457 CARRUESCO Date: 09/19/91 r"ia'ii :opr PTiated= Facility Name Fac ID Rep to inventoried FACILITY Location: 1420 G r AN� z,j N �- Il ep (r► vc y (Must have FACILITY IDO ) C,,)rnpalainant: MARY..,.MEAYS............EHD_......................................._..._._......................................._......._._Home Phone: Address: Work Phone - ..........-.........._..... ..........._..................................._.__........................................... ................................... ..._... FACILITY LOCATION/Property Info — DBA or Name : _. ` �1d� Com` .._ Loc Code . ..r......_................._.. .._................._....................... _ ................................ _._.............-............ Addres:. • ................._........__.-_................................_.......____................................................._........BQS Dist . �il."y APN # PhQii BILLING RESPONSIBLE PARTY or OWNER Info — Name t� POSTE.......... ......._.... Nome Phone- ) . ;tc: drE:SS Work Prone city . N6ture of Compiai.it' RECIEVED COMPLAINT IN FIELD . SEPTIC SYSTEM FAILURE . AD COMPLAINT Info — ",V--,INT MCDE: a-Agency Referral B-BD IF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence 0-0tner EH Unit P-Phone ;.3MPLA:N7 STATUS" "-F-'eld Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated 06-Transfer to PTeffliSe File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness Send Referral Letter to: Address: Reftrrd! Letter Sant by . Date , �L, i9 appropriate Uric i if comclaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated orarcaa to ".;.T TII III IV for investigation