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'?. '��. � :: i�.f4��,,,; c ar JJ'=.CO)TN COUNTYF'U3t I � is�:ALTH SFRVIC x?Por+ �5iO4 <br /> R(a b>, SHELLY.[& page 3 <br /> Ccs y = 01 of ?1 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT 3# 00004758 Program/Element, 4400 <br /> Taken by : 6626 SHELLY PRATER Date; 10/04/95 Assigned to 0756 CARO! 07 Date' 10/04/95 <br /> Hard Copy Printed: <br /> Fr,_.Uit,• Name. t=ac. ID <br /> BILL to inventoried FACILITY' <br /> Location. 1.244 OPO AVE (Must have FACILITY IDn) <br /> complainant '. TOM. .0R1 CH,TA Home Phoro- 209--465-5570 <br /> Address- Wc>> k Phor� <br /> FACILITY LOCATION/Property Info — <br /> OBA .. Name . Loc Code <br /> .......... <br /> Address Sa,..-t..• 1305 Dist <br /> ... ....,.... ..,....... <br /> City : A P N # <br /> Phone <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name - _........................................._._........_... ._ _....._...._. , ._ ..Horne Phone <br /> Address .._.......Work Phone: <br /> City : <br /> t <br /> `taturs of complaint: <br /> CARBACF <br /> COMPLAINT Info — <br /> COMPLAINT NODE: o PKINE <br /> A-agency Referral B-BD OF Supervisors/C,itY Ccoancil C-C0vnter M-MaillCorrespordence <br /> O-Dt e# FH Unit P-Phone <br /> COMPLAINT STATUS; Zj <br /> 0i-}ield Abated 02-Office Abated 03-NRI p v4-Notice to Abate Issued 05-Enforce ACT Ir-itiat?d <br /> 06-Transfer to Premise File !7-Refer to 00ar Agency 08-Nat Valid 09-Foodborne I11-gess <br /> .ircle appropriate Unit 0 if Complaint in another PRURAM jurisdiction, Have Ccmalaint Record and PIE updated <br /> Forwarded to UNIT: I ?' III rV for 'nvestigatior� <br />