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..........................................................................................................................................................................................................................................................._................................................................................................................................... <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SHORT TERM COMPLAINT FORM <br /> DATE: 3 j INSPECTOR(LASTNAME): COMPLAINT NO: BOO g u 7g <br /> TAKEN BY(LASTNAME): �n-7 Z PROGRAM: FACILITY ID NO: <br /> DISTRICT: LOCATION: APN: CROSS STREET: <br /> PREMISE ADDRESS: ST# STREET NAME CITY zia <br /> DBA: <br /> OWNER/OPERATOR: 14 Uri V, 1T l4,,0 CG6i Z - - <br /> ADDRESSITELEPHONE: 3 <br /> COMPLAINANT NAME: v►e�► mcm P - <br /> ADDRESSITELEPHONE: YItwu maAl <br /> COMPLAINT: 1 -ers)✓) ( 1 S-a° rmi Q(/PIO rtguw - <br /> L'elllV7� v 1 0 r-ay bad <br /> (A)Agency Referral (B)Board of Supervisors (C)Counter (E)Code Enforcement (F)Fax(I)Intemet/Email (M)Mail/Correspondence (0)Other/EHD Unit (P)Phone <br /> EHD 48-03 <br /> 5/9,12 <br />