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Dat r� i�.F �J6-'?7.!� , aAN jOAQUTN COUNTY PUL?[. Tr- HE�,.LTH SF RVTC Report #5104 <br /> Ri.in by MARYY Page ii <br /> Copy # = 01 Of 01 COMPLAINT TNVErSTIGATION REPORT <br /> COMPLAINT —C0004148 Program/Element. : 3600 <br /> Taken)k ' 9051 MARY OSULLIVAN Date: 06127/95 Assigned to : 9151 MARK BAPCEELKC Date: 05127195 <br /> Hard cony Printed: <br /> Facility Name: Fac ID: <br /> BILL to inventoried FACILITY: . <br /> Location: '2800 TRACY DLVI' TPACY F)ARK 40 (Must have FACILITY ID#) <br /> C<�Mplainant: BEVERLY AVILAAAAAA Horne Phone. 209--835 --9888 <br /> Address = Work Phone : 510-582-8812 <br /> FACILITY LOCATION/Property Info – <br /> DBA or Name, J7 JQY MA.NACER Loc Code <br /> Address BOS Dist <br /> APN = <br /> Pl-�one - 209-836--5000 <br /> BILLING RESPONSIBLE PARTY or OWNER Info – <br /> Name- Home PI-)one <br /> Address: Wc.) -k. Pyrone : <br /> City : <br /> Mature of Complaint: <br /> POOL Iw FILTHY . 7AQUZ7'I IS FILTHY 700 . <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P PHONE <br /> A-Agency ReferTal B-BD OF SupervisoTs/City Ccouncil C-Counter M-Mail/CcrTesponder�ce <br /> 0-Other EH Ur•it P-Phone <br /> ,OMPLAI!IT STATUS: (� <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> �ransfer 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: I1 III Itr for Investigation <br />