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04 <br /> Run F MARYF Page� er a V <br /> copy # 01 of nL OMP AINr INVESTIGATION RF_PORI <br /> COMPLAINT # - C0005608 Pra ram/E1em nt 1 3525 <br /> Takeo by : Ph; PANE HIN90N Oita 0L_ l* Assigned to 05? HOE HINSON Coe: 000 <br /> Haid copy Priotei: <br /> Facil. it-- Nude ' Fac JIT : <br /> SILL to imrentoried TAC;LIi'r <br /> Location' V: � LJ-_ � 7naNTA6L_ � I- (Mue. hste FACr�t!Y rD4i <br /> <br /> <br /> <br /> <br /> <br /> . <br /> FACILITY LOCATION/Property Info — <br /> DBA of Namw Loc Coda <br /> c LLy- PPN 4 , <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : Home Phone , <br /> Addrese : sock phone - <br /> = City ; <br /> Naure of Complain[ <br /> -j MONITORING WF_LL. CHRISTIE BOXES INSTAL..LED AROUND FORMER UST LOCATION <br /> NO PERMITS TSSUED , <br /> COMPLAINT Info — <br /> COMA43T MP°' P PHONE <br /> A-Agency peferrel B-BC IF `u"'ovisors/city CC"'Uncil C-Counter M Mai:!(prrespnnderce <br /> G-Otbe'r EH 'init P-Phone <br /> 0ARAiNT STATUS: <br /> 4:-Field Abated 020W Heated 030I Sent 041oUce IP Abate Issued 05-Enferce ACT Lutiated <br /> Oe-Transfer to Premise File 07-Refer to Other Agency 09-Not Valid 09-Foodborne IllnesE <br /> Circle appropriate Unit d if complaint in another PROGRAM uradictiop, Have Complaint Rec;rd and PIE updated <br /> Forwarded to UNH i P! .4 for investigation <br />