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.A e r CAROLD5AN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 45144 Page # 6 ' "Opy *:Ce. 01 of 09 COMPLAINT INVESTIGATION REPORT COMPLAINT. # = C0011261 Program/Element : " Taken by : 6519 05A Date: 11/09/98 Assigned to : 0740 ASKANAS Date: 11/09/98 Hard copy Tinted: Facility Name : Fac ID: BILL to inventoried FACILITY: Location= 1.765,_...,W. _HAZEL.T0N (Must have FACILITY ID#j Complainant: JERRY_ HE.RZ.ICK Home Phone: 209--468w-3121 Address: ...................................._..............._............._...... ...._....__....._......__. .. Work Phone STOCKTON CA ......_................................. FACILITY LOCATION/Property Info -- DBA or Name 111-111.1.1Loc Code Address : 1'7.65... W. H.A.Z LION AYE................................ _ BOS Dist City: STOCKTON. APN # : 145 -0.80-31 Phone : BILLING RESPONSIBLE PARTY or OWNER Info — Name- RAU. A__..pAbILLA ......__..Home Phone : ............ ............_....... Address. 1765 ._W HAZELTON Work Phone, .. .................-.._-_-____............_........................._.........._......_..... City : STOCKTON CA ..................11-- .... _.......... Nature of Complaint: UNSECURED VACANT HOUSE , NO WINDOWS . COMPLAINT Info — COMPLAINT MODE: M HAIL/CORRESPONDENCE A-Agency Referral 8-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence O-Other EH Unit P-Phone COMPLAINT STATUS: W .............. 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued05 Enforce ACT Initiated 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-F orne Illness Send Referral Letter to: Address: Referral Letter Sent by : ,u Date: Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated F6rwarded to UNIT: I IT III IV for Investigation