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Report <br /> Date run: 01/03/96 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC PageAs�42 <br /> Run by : MARYO <br /> Copy ft � 01 of O1 COMPLAINT INVESTIGATION REPORT <br /> �= Progr_am/Ele ent TYI <br /> COMPLAINT # = C0005264 Assigned to 1968'JERRY YOSHIOKA Date`• Ol/03� �� j <br /> Taken by : 1968 JERRY YOSHIOKA <br /> Date: 01/0312/ r <br /> Hard copy Printed: Fac ID <br /> Facility Name —. BILL to inventoried FACILITY <br /> Location: 1400 WATER�00 ROAD, <br /> (Must have FACILITY IDI) <br /> Home Phone: <br /> Complainant: CAPT UG6.R000CH--__- ------ Work Phone: <br /> Address: Sj OT KTON FIRE _- <br /> FACILITY LOCATION/Property Info — <br /> Loc Code : <br /> DBA or Name: VAN DEN BERG FOODS BOS Dist : <br /> Address: 1400 WATERLOO APN # <br /> City: STOCKTON <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info — Home Phone: 209-466-9580 <br /> Name: — Work Phone: <br /> Address: 1400 WATERLOO ROAD — ---- <br /> City: STOCKTON CA 95208 <br /> Nature of Complaint: <br /> CLORINE GAS LEAK <br /> COMPLAINT Info — <br /> COMPLAINT MODE: —. <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/COTT espondence <br /> O-OtheT 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-TransfeT to Premise File 07-Refer to Other Agency 08-Not valid 09-Foodborne Illness <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> forwarded to UNIT: I II III Iv for Investigation <br />