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viceiR-! r UII • VO/_L /-; �FiIV ,JUWI,U11-! UUUfV I Y WUbLIU HLRL IN �tKVllr KepOr[ 4« M <br /> Run by : CAROLDA0 Page # 5 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0010436 Program/Element 1320 <br /> Taken by : 0467 CARRUESCO Date: 06/16/98 Assigned to : 0467 CARRUESCO Date: 06/16/98 <br /> Hard copy Printed: <br /> Facility Name: ........... Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: 10 W MOSSD................. <br /> Complainant: <br /> <br /> <br /> a <br /> FACILITY LOCATION/Property Info — <br /> DESA or Name: Loc Code : <br /> _...._._.........._ <br /> ..._............._........__.........._...._ ................- ........................... .. <br /> ........... <br /> .. <br /> ,....... <br /> Address= 10 W MOSSDALE gbS Dist : <br /> City: STOCKTON. APN # <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name : Home Phone : <br /> ............ <br /> .................. <br /> _........._..............._......-..............._.................._................................_........................................_ <br /> Address: Work Phone : <br /> City . <br /> Nature of Complaint: <br /> POSSILBE SUBSTANDARD STRUCTURE . NOT VALID . <br /> COMPLAINT Info -- <br /> COMPLAINT MODE: <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other Eli 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 0-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated <br /> Farwarded to UNIT: II III IV for Investigation <br />