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Date rwn: 05/27/98 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 45104 <br /> Run by : CAROLII/ Page # 1 <br /> Copy # _: 01 of 0 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0010290 Program/Element : 4300 <br /> Taken by : 1699 YOAKUM Date. 05/26/98 Assigned to : 1699 YOAKUM Date: 05/27/98 <br /> Hard COPY Printed: <br /> Facility Name: MOSSDA-LE_..._MARINA. Fac ID : 09.0220 <br /> BILL to inventoried FACILITY: <br /> Location= 7,......,.._.._............-W......ST_EWART....._RD. (Must have FACILITY 100) <br /> Complainant : <br /> <br /> : <br /> E6-Ll_ 36 <br /> FACILITY LOCATION/Property Info <br /> DBA or Name: MOSSDALE M Loc Code : 07 <br /> ..........................................._..._........ ........._....._......_.._...._._ ..,:........_......_................................................................................ <br /> Address= 73 W S RT RD BOS Dist : 003 <br /> . _._................................_...._.........._.._........._........_......._...._... _.......... <br /> .................. <br /> City: LA._...,.._ ©P. 95330 APN # <br /> Phone . 09--982-0512 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: RA DFORD...�.......... &._...ELt/A..........._.............._...........................................,......_........_Home Phone : 209-982-0512 <br /> Address: 324....... M...........PRIK....................................................................._.......-............................._.._..,......_Work Phone : 209-982--0512 <br /> City: E.C.A. CA, 9 336 <br /> Nature of Complaint: <br /> REQUEST WELL COLIFORM TEST IN FLOOD AREA . �1 <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <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 /> 01-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 08-Not Valid 09-foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral. Letter Sent by: Date: <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I II III IV for Investigation <br />