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{ Date ruin: 09/29/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 45104 Run by : CAROLINE Page # Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT j w COMPLAINT C0002632 Program/Element : 3203 Taken by : 0740 BRUCE ASKANAS Date: 09/28/94 Assigned to : 0740 BRUCE ASKANAS Date: 09/28/94 Facility Name : M_I_CIC.E.....C,R©VE....-_ZO©LO.G,ICAL._.-_ OC_I TY' Fac ID : On4291 i BILL to inventoried FACILITY: Lqcat inrs s 1.1,793 (Must have FACILITY ID4) � : FACILITY LOCATION/Property Info k DBA or Name: M.C.K.E...._GR_bV ......Z,OQI�.00. _GA1.-..... O .S ,TY......._...._._..._........._..........__............................_Loc Code : 99 Address'. 11,793......M.... MICKE GROVE......ROAC�.. _..... _. _. -.....SOS Dist 004 � Cit' ,: LOP.T. APN # i i Phone: BILLING RESPONSIBLE= PARTY or OWNER Info — j Nave: M. CKE,,,...GROVE....._ZoQLJCS.1_CA_1:....._SOCTETY....._. _._._....._...............Home Phone: Address. .1 117 j ...^.....__g3.. N MICKE....� E......i�C7Ap�......_................... ....._..._..._..War k Phone: � ` City : LODI CA Nature of Complaint: I BIRDS EXPOSED TO PESTICIDES—MUST BE QUARRANTIED FOR A LEAST 45 DAYS-- k I IN MICKE GROVE ZOO j � I I I COMPLAINT Info I COMPLAINT MODE: A._..,..„._AGENCY REFERRAL 1 A-Agency Referral B-8D OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence i � 0-Other EH Unit P-phone 5 i COMPLAINT STATUS: 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated Ob-Transfer to Premise File 07-Refer to Other AgencY 08-Not Valid 09-Foodborne Illness I I I f j � I Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated j Forwarded to UNIT: I Ii III IV for Investigation i I '