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Date run: 08/26/9 L/SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> Run by : MARYFIC(O- Page # 3 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # : C0006770 Program/Element : 13BO <br /> Taken by : 0997 HARLIN KNOLL Date: 08/23/96 Assigned to : 0843 MICHAEL COLLINS Date: 08/23/96 <br /> Hard copy Printed: 08/26/96 <br /> Facility Name: Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: 6550 E . HWY 12 (Must have FACILITY ID#) <br /> Complainant : LOO.I.„.-POL-I.CE......DEPT..........................._....................._..._ _...__....-...................Home Phone : <br /> Address: Work Phone: <br /> FACILITY LOCATION/Property Info — <br /> DBA or Name : Loc_ Code <br /> Address: _ ................................_BOS Dist <br /> City: APIC # <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: NUSRAT......NASI.M...._MAL-I-K-....-.-.-....-..--..-............................ ................-.-._.._......__._Home Phone: <br /> Address: P,-.O_„-_BOX,..,.,7432 ___,--,_, -,_ ..,.Work Phone: <br /> City: SHAWNEE..-_MI.SS.I,ON_ KS 66207-432 <br /> Nature of Complaint: <br /> HOUSE , WELL , SEPTIC & OLD TIRES NEED ABATEMENT . <br /> J'74 IZ <br /> COMPLAINT Info — <br /> COMPLAINT MODE: A AGENCY REFERRAL �� <br /> A-Agency Referral B-BO OF Supervisors/City Cccuncil C-Counter M-M ' pondence C <br /> 0-Other EH Unit P-Phone =._ <br /> COMPLAINT STATUS: . r9�� <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated �, 2 <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated' <br /> Forwarded to UNIT: 0 II III IV for Investigation <br />