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Date run : 07/20/95 SAN JOAQUIN COUNTY PUBLIC HE=ALTH 5ERVIC Report 0104 <br /> Page � <br /> Run hY : MARYO[Ck <br /> Co : pl of 01 COMPLAINTINVESTIGATION REPORT <br /> COMPLAINT # = coo U4' 57 Program/Element : 2315 <br /> Taken by : 0008 LETITIA BRIGGS Date: 07/20/95 Assigned to : 0008 LETITIA 8PIGGS Date: 07/20/95 <br /> Hard copy Printed: <br /> Facility Name: Fac ID: <br /> BILL to inventoried FACILITY <br /> Location: ­I-9_ Q._ ..,..M.I_� R_...._AVE. (Dust have FACILITY IOR) <br /> Complainant: .. .Home Phone: 209-T937-8835 <br /> CAF :T...-......_KUHKEt�....._C4S......Cw._I_RF.........................................._. .. <br /> ........_..._..... <br /> f Address: Work phone : <br /> i <br /> FACILITY LOCATION/Property Indo — <br /> DBA or Name: Or <br /> SfaG K�zs� o ods Loc Code <br /> ....... ......._.................._......._.............................................._._.._..... SOS Dist: <br /> Address: .. <br /> City: �Sf'oG� ri� C/+ �Jra�Jr APN <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Home phone : <br /> Name : <br /> Addross: Work Phone: <br /> ......._........._..._.... ......_._.... <br /> City : _ ........... . <br /> Nature of Complaint: <br /> RECEIVED UGST PLAN NO PLAN SiJBMI.TTED TO PHS—EHD . LETITIA BRIGGS WILL <br /> FOLLOW UP ON TANK INSTALLATION . FACILIATY ID # 2313.84 <br /> COMPLAINT Info _ <br /> COMPLAINT MODE: PHONE <br /> A-Agency Referral 9-BD OF Supervisors/City £council C-Counter M-Mail/Correspondence <br /> O-other EH Unit P-Phone <br /> i <br /> i CONPLAIMT STATUS 1 _ <br /> 01-Field Abated 02 Office Abated 03-MAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 05-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit 9 if complaint in another PROGRAM jurisdiction, Have Complaint--Record and P/E updated <br /> t <br /> Forwarded to UNIT, 1 11 II IV for Investigation <br />