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Date run: 04/23/98 AN JOAQUIN COUNTY PUBLIC HEALTH SERV IC Report 15104 Run by : CAROLCY' Page # 1 Copy #� : 01 offs COMPLAINT INVESTIGATION REPORT COMPLAINT # C0010105 Program/Element :: 4200 Taken by : 6519 DISH Date: 04/22/98 Assigned to : 0102 MIMDT Date; 04/22/98 Hard Copy Printed: Facility Name: SAFEWAY.._ MEAT,._._PR©CESS,I,NG...__PLANT Fac I D : 095.61.7- BILI. to inventoried FACILITY: Location: 1111NAVY DR (Must have FACILITY IDO) .-_......................................... Complainant : MR ._._SI,LVA........._....._........_. ..._................................_....................................Home Phone: 209--948--6956 Address: Work Phone: FACILITY LOCATION/Property Info — DBA or Name: SAFE"WAY..._.MEA_I"_..._PROCESS.I_NG.....-PLAN....._................................ .._.............,....._........... Code : n.1.. Address: 1.1..1._1NAVY....--.DR..._........_................ BOS Dist : City: STOCKTO.. 95206 APN � Phone: BILLING RESPONSIBLE PARTY or OWNER Info - Name: SAFEWAY......STORES. INC........_............................._._ ............_................_....._..................._Home Phone: Address: 800.__.._.__IGNACIO..._VALLEY....._RO.._....._._._...__....._..._.._..__...._.......___......_---Work Phone: City: WALNUTCREEK CA 94598 Nature of Complaint: ,3 SEDIMENT POND SMELLS SO BAD IT 'S MAKING PEOPLE IN THE AREA SICK . 90y �3 COMPLAINT Info — 3yy3 Qo4 +�� /� COMPLAINT MODE: P PHONE k/ C C 13- 54 G. C , A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence O-Other EH Unit ?-Phone COMPLAINT STATUS: 01-field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated 06-Transfer to Premise file 07-Refer to Other Agency 08-Not Valid 09-foodborne illness Send Referral Letter to: Address: Referral Letter Sent by: Date: Circle appropriate Unit i if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E,updated Forwarded to UNIT: I II III IV for Investigation M a