Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SHORT TERM COMPLAINT FORM <br /> DATE:.— i Z. — INSPECTOR(L4STNAME): .F COMPLAINT NO: <br /> TAKEN BY(LAST NAME): LGA V� �Z PROGRAM: FACILITY ID NO: 22 <br /> DISTRICT: 2— LOCATION: APN: 117 t} — CROSS STREET: <br /> PREMISE ADDRESS: sT* STREET NAME �`�, I i., c. { i ..... CITY <br /> DBA: , va <br /> OWNERIOPERATOR: <br /> ADDRESSITELEPHONE: <br /> COMPLAINANT NAME: <br /> ADDRESS/TELEPHONE: <br /> COMPLAINT: <br /> ' G <br /> <br /> 4p=� <br /> (A)Agency Referral (B)Board of Supervisors (C)Counter (E)Code Enforcement (F)Fax(I)lntemet/Email (M)Mai l/Correspondeuce (0)Other/EHD Unit (P)Phone <br /> EHD 48-43 <br /> 5/9112 <br />