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i <br /> Date run: 12/10/93 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 s <br /> Run by SYLVIA Page 0 4 <br /> 'COPY K 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> MA�lI�fR 1�MMMAfMMMMMMMMMMMMMMMMMMMA?A�dMMMMI�IMMMMMMMMAfMMMMMAlFONMAA�IMMMMMM7�lPlMMMM <br /> COMPLAI tS' : 00001166 Program/Element 4200 <br /> Taken by : 0618 CAROL CARBAJAL Date; 12/10/93 Assigned to 0363 KELLY NCCOY Date: 2/10/93 <br /> Facility Name; CHERRY LANE GROCERY Fac ID: 001204 <br /> BILL to inventoried FACILITY: <br /> Location: 11225 E HWY 26 (Must have FACILITY IDp) <br /> Complainant; AN Home Phone: <br /> Address: Work Phone: <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name: CHERRYLAND GROCERY STORE Loc Code 01 <br /> Address: 11225 HWY 26 • BOB Dist 001 <br /> City: STOCKTON 95206 APN 9 <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OMNER Info - <br /> Name:/ LA&4T-A-PA*ft YV16h'^O-V-- Home Phone: <br /> Address:, <br /> _— <br /> Nature of Complaint: <br /> SEPTIC TANK OVERFLOWING - <br /> COMPLAINT Info - <br /> COMPLAINT MODE: P 'PHONE <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STATUS: <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit 9 if complaint in another PROGRAM jurisdiction, Have Complaint Record and PIE updated { <br /> Forwarded to UNIT: I II III IV fpr Investigation <br /> t' <br /> t <br />