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Date run: 05/05/97 SAN JOAQUIN COUNTY PUBLIC HEALTH SFRVIC Report x5104 <br /> Run by : KAREN/W Page # 2 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C00081-36 Program/Element : 4300 <br /> Takpn by : 0467 JEFF CARRUESCO Date: 05/05197 Assigned to 0467 JEFF CARRUESCO Date: 05/05/97 <br /> Hard Pope Printed: <br /> Fa • ility Name : _ Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: 10 WEST MOSSDALF lNust have FACILITY [Do), <br /> Complainant : EILEENHome Phone: 209-601 -0891 <br /> Address : Work Phone: <br /> FACILITY LOCATION/Property Info – <br /> DBA or Name: Loc Code : <br /> Address : BOS Dist : <br /> City: _ APN # <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name : _ _ Home Phone : <br /> Address : Work Phone: <br /> City: ---_ - ---- - -- — <br /> Nature of Complaint' <br /> Eileen is requesting a water test . <br /> COMPLAINT Info – <br /> COMPLAINT NODE: P PHONE <br /> A-Agency Referral 8-81) OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EN Unit P-Phone <br /> COMPLAINT STATUS: <br /> 01= id d Abated 01-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> Transfpr to Prpaicp File 07-Refer to Other .Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address : <br /> Referral Letter Sent by: Date: <br /> Cird a appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> Forwarded to UNIT: 1 11 III IV for Investigation <br />