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Q_-7 SAN 7OA0i iIN rni_iNTY PUBLIC HEALTH SERVIC Report #5104 <br /> hey - R0(_.D� Page f# 4 <br /> 01 of �'0 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0008851 Program/Element = 4400 <br /> Taken by : 3304 ARMSTRONG Date: 08/21/97 Assigned to 0756 OZ Date: 08/22/97 <br /> Hard copy Printed: <br /> Facility Name: Fac ID : <br /> BILL to inventoried FACILITY: <br /> Location: _7 �c__.TEEPEE.. DR VA (Must have FACILITY IDC <br /> Complainant : <br /> : <br /> FACILITY LOCATION/Property Info - <br /> LOC Code <br /> 64 BOS Dist <br /> CiL _- A P N <br /> Phon(_ CV0/ r Ca y 2 <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name' .1 . C-iROPP _ ...........Home Phone: <br /> Addmis: Work Phone : <br /> .. ....................................... <br /> Mature of Complaint= <br /> EXCESS DOG FECES . <br /> COMPLAINT Info - <br /> COMPLAINT MODE' <br /> 4-Agency Referral ?-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> -Other EH Unit P-Phone <br /> Abated 02-Office Abated O3-NAI Sent O4-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 /> Send Referral Letter to: <br /> Address: <br /> Terr. 1 l_ t.t -r :: Date : <br /> ^:rr �o nrr-,�^-_❑ �I.�.' +' :f r.n�rynl,_n: _n �nnt her pDf�f�?QM Jurisdiction, Have Complaint Record and PIE updated <br /> UNIT: I II III IV for Investigation <br />