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Report #5104 <br /> N l�/\�U�N UNTY PUBLIC HE�LTH 'SEFlVIC <br /> [J <br /> Run by r CARDLD Page <br /> copy # : 01 of 6— COMPLAINT INVESTIGATION REPORT <br /> ~ _ <br /> COMPLAINT C0009019 Program/Element. 2531 <br /> Taker. by : 0606 THEVEHA 'ate' D9/17/97 Assigned to 0606 TREV[NA Date: 09/17/97 <br /> Ka:- .o° Printed <br /> Facility Name' Fac IO: <br /> 88l to iovonturied FACILITY: <br /> Location: <br /> pA{ IFZ[ AVE (Must have FACILITY 00) ----- <br /> Cumplainunt : STJC�T�N_� _____ Home Phone: <br /> Address , Work Phone . <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: _J���lJ�.N_{}��T.A_Cl.Q L-L-E..G E ..........._............................... .............. ............_....... _Loc Code : <br /> Address ' BOS Dist : <br /> City ; APN # � <br /> Phone , <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name _ _ _ _ _-Home Phone : <br /> Add/ et�;s : Work Phone. <br /> City , <br /> Nature :f Complaint: <br /> MERCURY SPILL IN CUNNINGHAM 4215 ' <br /> COMPLAINT Info — <br /> ^DMPLAINT MODE. PHONE <br /> A'h4o%/ Refmo. B-BD J Supervisors/City [council :-Ccunt�r H-Mail/Conmcpondenoo <br /> O'0thor [� Unit P-Phone <br /> C�MPLAINT S7AT8G: 0& <br /> ' ` hated 3�-8ff�cu Abated 03'NAI Sent 04'Notioo to Abate Iayuod 05-Enforce ACT initiated <br /> to Promise File 87-Refer to Other Agency 08-Not Valid 09-Fovdborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by ; Date: <br /> C�rcls appropriate Unit # if complaint in another PROQ8AM ju,iodiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I %l IV fmr lnvontiVat�vn <br /> �� <br />