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rnnn! rn r-n' In,T-v 01IRi T!^ HE ^,I..TW 5 -f- +., rr Report W;Iot <br /> Run by rr4Pnl n/rte Papa +t <br /> copy 01 of n1. COMPI_ATNT TNVFSTIGATTnN RFPORT <br /> COMPLAINT # C0008646 Program/Element 4300 <br /> Taken by : 6519 DISA Date: 07/22/97 Assigned to0756 ate: 07/22/97 <br /> Hard copy Printed: <br /> Facility Name - Fac ID : `j A- <br /> RILI_ to inventoried FACII-TTY' <br /> Locat ion: [ir.�",c. L f FF.I ^_,I; !Mi'ct havo FA(TI_TTY TDO 1 <br /> Cr->rnr1 :_. . ri rit <br /> ^ <br /> FACTLTTY LOC'ATTON/Property Info — <br /> SRA. i;Y �IamA ' L_c�C Cnd <br /> r i t•., - nPP,I ff <br /> Phone - <br /> BILLING RFSPONSIBLE PARTY or OWNER Info — <br /> �I �n. Home Phone' <br /> Work Phone- <br /> 11AS TFc,TFD POCITTT` F cnc, r_ TnPPF(? . NOT `✓' IPF TF (,,,'FI I Op t AKF <br /> COMPLAINT Info — <br /> 'IMPI.�INT MODEDUOM[ <br /> A-4gen(y Referral 5-90 OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> COMPLAINT STATOS, <br /> OI-Field Abated 02-Office Abated 0?-NRI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency OA-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address <br /> P efer r a 1 l <=t-t e S ent 1:�v __.-. _ Oat <br /> Circle aporopriate unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I Q III IV for Investigation <br />