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Date run: 10/18/99 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC - Repbrt #5104 <br /> Run by :TDENORA Page # 2 <br /> Cody # : 01 of 01 COMPLAINT INVESTIGATION ' REPORT <br /> 1'1MNJJ'7MMh1MMMMMMMMMNIMMMWIMMMMMf�'lIMMMT'JMl`'IMNJMlofM1�'JM�'IMMMMh1MMMMM1ylP7HJMMNJMMh1MMMMMMNfMMhJMMMMMT?MMM <br /> COMPLAINT # : C0013136 . . Program/Element : 4400 <br /> Tarsen by : 7829 GAGAZA Date: 10/18/99 � Assigned to : 1699 YOAKUN Date: 14/.18/99 <br /> Hard copy Printed: <br /> Facility Name: ARCO .#6.1.0R..._AM/PM. Fac ID: on9.,334, <br /> P,4T-AejC -a&v AAs R�) BILL to inventoried FACILITY: <br /> Location: 257. - ...'........................................................................................._..................__ (Must have FACILITY I0#) <br /> Complainant: RACHAEL..._.0U,1,Nl, I.M..:....._......................._.... ........... <br /> Phone : <br /> Address: EHDwork Phone: <br /> ................................................................_................_...................._._......................__... ......__............. <br /> FACILITY LOCATION/Property Info — <br /> DBAor Name: ARCO..._#6,1,00....._AM/-PM......................._..........._....._.._._.._......._.............._........... ............._......_.........._....................Loc Cade : <br /> Address: 2577....._5.._..MOUNTA_I_N...__H0USE .PKWY._...............__._...............__...._.__._._......._................_........._._BOS Dist : 005 <br /> City: .,RACY. 9537'6— 20 APN # <br /> Phone: 209-835-777'7 <br /> BILLING RESPONSIBLE PARTY or OWNER Info _ <br /> Name: ARCO....AM/PN_.._.... ........_..,.,....._........_........._......._:._._..............................................................................__Home Phone : <br /> Address: Ob_K.......,. .y..SS.................... Work Phone: <br /> City: t' ./� 9005'1 <br /> Nature of Complaint: <br /> TIRES , PAPER AND GARBAGE BEHIND STATION <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency Referral 8-BD OF Supervisors/City CCOURCil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: O 1 <br /> 1-�,eld Abated 42-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 6-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 49-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 P/E updated <br /> Forwarded to UNIT: III III IV for Investigation <br />