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Date run: 08/26/96, 5AN JOAUUZN COUNTY PUBLIC HEALTH SERVIC Report 15104 <br />� <br />Ru'fi by MARYFJ C(7 Page # � <br />Copy # 01 of 01 COMPLAINT INVESTIGATION REPORT <br />COMPLAINT # C000006770 Program/Element : 13�r�� <br />Taken by : 0997 KAHLIN KNOLL Date: 00/23/96 Assigned to : 0843 MICHAEL COLLINS Date: 08/23/96 <br />Hard copy Printed: 0026/96 <br />Facility Name: Fac ID: � <br />BILL to inventoried FACILITY: <br />Locationz6550 E. HWY 12 (Huot have FACILITY DN) <br />Complainant: <br />Address: <br />FACILITY LOCATION/Property Info — <br />DBA or Name: <br />_ <br />Address: ^� <br />City: <br />Phone: <br />� Loc'Cude � <br />5OS Dist � <br />APN # <br />BILLING RESPONSIBLE PARTY or OWNER Info -~ <br />Name: NUSRAT NASIM MALIK Home Phone; <br />Address: P.O. BOX 7432 Work Phone: <br />City: �� 66207-432 <br />Nature of Complaint: <br />HOUSE, WELL, SEPTIC & OLD TIRES NEED ABATEMENT' <br />� <br />COMPLAINT Info — <br />-- — <br />COMPLAINT MODE: A AGENCY REFERRAL <br />A -Agency Referral 8-80 OF Supervisors/City Ccounnil C'C000tor M- pvmbono <br />U'0thor EH Unit P -Phone <br />COMPLAINT STATUS SlA0S : _4 <br />01fioN Abated 02-Offioo Abated 03 -NAI Sent 04 -Notice to Abate Issued 05 -Enforce ACJ Initiated — <br />06-T/xmafor to Promise File 07—Refer to Other AV000y 00 -Not Valid 09 -Foodborne Illness ^�~- - <br />Circle appropriate Unit 0 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated" <br />Forwarded to UNIT: 0 11 111 IV for Investigation <br />