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le run : uz/uu/qJ AN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by : CAROLp ;; Page # 4 <br /> Co <br /> Py # - 01 of 0-1J COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0011680 Program/Element 1632 <br /> Taken by : 6519 DISA Date: 02/06/99 Assigned to : Date: 02/08/99 <br /> Hard copy Printed: a <br /> Facility Name : MOKELUMN.E..._,.RJYE~.R._...SCH.00L ' Fac ID : 004275'' <br /> BILL to inventoried FACILITY: <br /> Location: 18950 N HWY_._99. (Must have FACILITY ID#) <br /> Complainant_: LIZ...._H_I_TTLE......_......_..........._ . ._................................................:......:........._...._......._.........._Home Phone : ,' 209-367-0245 <br /> Address: „. . Work Phone : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: MOKE LIU.MNi ....._R_I_VER....SCH©OL_..._...._.._..._.._..:... ...:..:.::......................................_...... �_Lnc Code : 99 <br /> _._....... <br /> Address : 1,8950...N ..HWY., 99..... ........_ _..:........... .... . ..................:......._BOS Dist : 004. <br /> City : LOp1.. 95241 APN # WCMOKEL18 <br /> ..._........................................_... <br /> Phone : 209-368-7271BILLING <br /> ER Infg — Home Ph <br /> .. . .. .. ._......_._........... � .. H Phone: <br /> RESPONSIBLE PARTY or OWN <br /> Name GQEHRING ......_CLIA'FORD.......:..:....................... .. _ _....._,...._._.. 3 <br /> Address : 18950_.. N..._..HWY 99.,,.,.._._,_.._ . .Work Phone : 209-368-7271 <br /> City: LOp_I, CA 95241 <br /> Nature of Complaint: <br /> NO SOAP OR WARM WATER IN GIRLS BATHROOM . <br /> �9 <br /> COMPLAINT Info <br /> d <br /> COMPLAINT MODE: P_._...__PHONE <br /> ij <br /> A-Agency Referral B-80 OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> �J <br /> 01-field Abated 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-Foodborne Illness : <br /> Send Referral Letter to= <br /> I# <br /> Address: <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit A if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> y 19 <br /> Forwarded to UNIT: V II III IV for Investigation <br /> Il:, <br /> fv iP <br /> t <br />