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' Date run: 07/22>>>/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by : MARYVWL� Page # 5 <br /> Copy # : 01 o 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : COOO6523 Program/Element : 346 j3Zt� <br /> Taken by : 6976 AL OLSEN Date: 07/22/96 Assigned to : 9157 NARK BARCELLOS Date: 07/22/96 <br /> Hard copy Printed: <br /> Facility Name : Fac ID: <br /> .........:.. nn11 <br /> Location: 5110 MARIPOSA ROAD �[A,K I� , BILL to inventoried FACILITY: <br /> ....._..._..._.........111_.1....._..._................1..1..1...,..........1........ (Must have FACILITY IDA) <br /> Complainant: <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: <br /> -----.._-..._.......-_.................._._--------...................___._._....._..._.............__..._.........__...-............._.........................-....__Loc Code <br /> Address: <br /> -------._........_._........._..._.......................__-_...-----...------__..._..._....___._....._......_.................--__..__'._..__BGS Dist <br /> City: APN # <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: .._......_.... i[��...._...�x7-....._.._._..._....................._.........----- Home Phone: <br /> Address: <br /> j'J..Zp .. / stt` TT.�t Work Phone: <br /> City* <br /> Nature of Complaint: <br /> PARTIALLY CONSTRUCTED 2 STORY DWELLING , VACANT & VANDALIZED . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: M MAIL/CORRESPONDENCE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> .............. <br /> O1-Field Abated 02-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 5 <br /> t Valid 09-Foodborne Illness <br /> Circle appropriate Unit N if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: (0 II III IV for Investigation <br />