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Date run: 10/05/998 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC � Report #5104 Run by : CAROLD Page ## 1 Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT MP�JMMMNfNIE"!P!1 YMP7Nff�lMl h7MMMNfMMMMNIMMMMMMMMP11�lMMMI~fMMMMMMP'}NJNff`JMMMMMMMMMNJMMMMf,IhJMf"frJMrilylfvJ.MMMMNJM COMPLAINT # = C0013074 Program/Element : -1,2eV ' Taken by : 5366 LINEBAUGH Date: 1 5 9 Assigned to : 5366 LINEBAUGH Date: 10/05/49 Hard copy Printed: l 7 Facility Name: ac ID : ! BILL to inventoried FACILITY: Location: 30.09.,_..S.,.__POCK......L'N (Must have FACILITY I00) Complainant. ..........._............ .....Home Phone: Address: _..................__..............___...............___..................................................................,.................___...........Work Phone, STOCICTON CA FACILITY LOCATION/Property Info - DBA or Name: Loc Code_ : ................._....._................................_ ............... _._.................._. Address : 34a9 ._ .... S,... POCK....._L.N._................................... ........................_................................:,..........._................_BOS. Dist City- S-OCKTON, APN # Phone : BILLING RESPONSIBLE PARTY or OWNER Info Name". . Phone: Address : Work Phone : City - ............ Nature of Complaint: OPEN , UNSECURED SFD AND BASEMENT . COMPLAINT Info COMPLAINT MODE: P PHONE A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence O-Other EH Unit P-Phone COMPLAINT STATUS: . 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05 Enforce ACT Initiated 06-Transfer to Premise File 07-Refer to Other Agency 06-Not Valid 09-Foodborne Illness Send Referral Letter to: Address: Referral Letter Sent by : Date: _ Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated Forwarded to UNIT: II III IV for Investigation