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Date run: 06/22/93 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> rzy ROSEMARY Page # 1 <br /> Capg� D1 of 04 <br /> MMMMMh�'�MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM <br /> COMPLAINT # : C0000150 Program./Element 3600 <br /> Taken by: ROSEMARY FLORES Date : 06/22/93 Time: 11 : 23 : 56 <br /> Assigned to Date : 06/22/93 Time: 11 : 23 : 56 <br /> Facility Name : TAHAMA VILLAGE MOBILE HOME PRK Fac ID: 001136BILLing Party: Y { N <br /> Location: 10750 N HWY 99 <br /> CORPLAINT Info - <br />` Complainant : <br /> <br /> I FACILITY LOCATION{Property Info - <br /> DBA or Name: TAHAMA VILLAGE Loc Code : 01 <br /> Address: 10780 N. HIGHWAY 99 BOS Dist : 0001 <br /> City: LODI 95240 APN # <br />` <br /> Phone : BILLing Party: Y 1 N <br />' <br /> OWNER Info - <br /> Owner/Agent: Home Phone: <br /> Address: Work Phone: ' <br /> 3 City: , BILLing Party: Y { N <br /> Nature of Complaint: <br /> BLACK WATER IN THE POOL - <br /> t <br /> X ' <br /> INVESTIGATION REPORT <br /> DATE ===_=BY DISPOSITION <br /> =_===.__---=-W==--=------------------------=-W====_ <br /> k 1 <br />} <br /> 1 r <br /> Service Code : -Action Code : Result Code: <br />