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Date run: 07/20/98 SAN JOAQUIN COUNTY PUBLIC HEAL I H btHV i�_ KeporL VIU4 <br /> Run by. CAROL D� Page # 2 <br /> Copy # 01 of 0r COMPLAINT INVESTIGATION REPORT <br /> s <br /> COMPLAINT # = C0010654 Program/Element 3612 <br /> Taken by : 7829 GAGAZA Date: 07/20/98 Assigned to : 0740 ASKANAS Date: 07/20/98 <br /> Hard copy Printed: <br /> Facility Name : Nf.EApOWGREEN,_.APAR.TM.EN S. Fac ID: O©_1.428, <br /> BILL to inventoried FACILITY: <br /> Location: 211W SAN CARLOS WY (Must have-FACILITY IDO) <br /> Complainant: Nk,ON.IQUE..............._.....-...-_._........................................................................._._.__-. ........._........Home Phone: 209-957-7104 <br /> Address : Work Phone: <br /> j <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name: MEADOWGREEN.. APAR_T,MENT,S..........:. Loc Code 0.1. <br /> Address: 21.A - .S.AN__.CAR OS_ WY.........._.............: _ ......... _._ _-...., BOS Dist : <br /> City: 5TOCKTQN, 95207 APN # ,: <br /> Phone: 209--473-2421 <br /> BILLING RESPONSIBLE PARTY or OWNER Info - w <br /> Name : OCCI_DENTAL._.._CAP_I..TAL...._HbLpINGS._...............__..............................__.._Home Phone: <br /> Address: 2454 ....._.SAN.......CARLOS .Work Phone: 510-885--1897 <br /> Nature C Play -; CASTRO .VALLE_Y CA 94546 p <br /> 5 I TER GREEN , PUMP BROKEN NO CHEMICALS USED . HER CHIL <br /> FROM POOL . SPA BOARDED UP . D GOT SICK <br /> 3 <br /> a <br /> ii <br /> i <br /> �i <br /> COMPLAINT Info — <br /> 9 <br /> COMPLAINT MODE: P PHONE a <br /> A-Agency Referral.. B-BD OF Supervisors/City CCOUnCil C-Counter M-Mail/Correspondence <br /> 0-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> 6-Transer to premise five Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 0fFine 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Date : <br /> Circle appropriate Unit 9 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> forwarded to UNIT:C) <br /> II III IV for Investigation <br />