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Date run: 03/09/98 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 <br /> Run by : CAROLD Page # 1 <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # = C0009769 Program/Element : 4200 <br /> Taken by : 6519 RISA Date: 03/02/98 Assigned to : 0102 MINOT Date: 03/02/98 <br /> Hard copy Printed: 03/02/98 <br /> Facility Name : Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location 314 S VENTURA #5 (Must have FACILITY I00) <br /> Complainant : <br /> <br /> <br /> <br /> <br /> DBA or Name: Loc Code <br /> .................................................................. .... . <br /> Address: - BOS Dist <br /> ................................................................................................................................................ <br /> City: APN # <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name : Home Phone : <br /> _.....-.... .......................................................................................... ................................ <br /> Address: ............,Wor k Phone' <br /> City <br /> Nature of Complaint: <br /> TOILET HAS BEEN PLUGED UP OWNER CAME OVER AND PUMP SEWAGE OUT OF <br /> TOILET WITH A HOSE INTO THE BACK YARD . TOILET STILL DOES NOT WORK . <br /> NO VENT PIPE IN HOUSE . <br /> 3 <br /> COMPLAINT Info <br /> COMPLAINT MODE: P PHONE <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: _06 <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 /> Send Referral Letter to: <br /> Address= <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit 0 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: I II III IV for Investigation <br />