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©LD�� _ Z>Him JUHUUIN UUUN 1 Y PUBLIC HEALTH SERVIC Report #5104 <br /> 'rl74A Page # 2 <br /> 01 of �1 COMP,G..AI-N INVESTIGATION REPORT <br /> ,,. ''AINT # = C0009287 Program/Element 1100 <br /> _,ten by : 6519 RISA Date: 11/04/97 Assigned to : 0794 MATHEW Date: 11/04/97 <br /> lard copy Printed: <br /> 'f <br /> Facility Name: WEST LANBOWLFac ID: 02383 <br /> ..... . . _ <br /> BILL to inventoried FACILITY: <br /> Location: 3900._...._WEST....._LANE. (Must have FACILITY ID#) <br /> Complainant: <br /> <br /> : <br /> FACILITY LOCATION/Property Info — <br /> DBA <br /> nfo =DESA or Name : WEST ,LANE....._BaWL,..........._............_....... Loc Code - ____ <br /> .........._._.........................._.............._..,._...._....._,.........._...._...................... - 01 <br /> Address: <br /> 3900......WEST.....LN­......_, ... .._. .............._E30S Dist 002 <br /> City: STOCKTON 95204 APN # <br /> Phone : 209-466-3317 <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: DELIlCGH.I..,P..,....RAY Home Phone : <br /> Address: 3900....___.....__WEST"......_LANE._._......_._............._...._.__._._..........................................._.......__.._.........._Work Phone: 209-466-3317 <br /> City: STOCKTON C .. 95204 <br /> Nature of Complaint: <br /> PEOPLE SMOKING AT DOOR OF BAR • �b,}C.11��, /��,� ` v <br /> PA-r CC A <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: <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04 N to Abate issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency 08- 0t Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Referral Letter Sent by: Date: <br /> Circle appropriate Unit I if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: II III IV for Investigation <br />