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Date run: 01/02/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 45104 <br /> Rur1 by : MARYF Page # 1 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : COOO5241 Program/Element : 2547 <br /> Taken by : 0418 MICHAEL KITH Date: 01/02/96 Assigned to : 0418 MICHAEL KITH Date: 01/02/96 ) <br /> Hard copy Printed: <br /> Facility Name : _ Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: HARNEY LN . 1/2 M . E . OF CLEMENTS /e� (Must have FACILITY ID#) <br /> Complainant: EVERETT POWELL/VIA COUNTY FIRE Home Phone: <br /> Address : Work Phone: 209-727-0401 <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : Loc Code : <br /> Address : BOS Dist : <br /> City: _ APN # <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: Home Phone: <br /> Address: Work Phone: <br /> City : <br /> Nature of Complaint: i^ <br /> ILLEGAL SEWAGE DUMPING MK RESPONDED <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral 8-8D OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: _01 <br /> O1-field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborns illness <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 />