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Date run: 04/19/96 SAN 70AQUIN CO P BLIC HEALTH SERVIC Report #5104 Run by : MARYO Page # 1 Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT COMPLAINT # = C0005918 I Program/Element : 2531 Taken by : 0418 MICHAEL KITH Date: 04/18/96 Assigned to : 0418 MICHAEL KITH Date: 04/18/96 Hard copy Printed: 04/19/96 Facility Name: Fac ID: BILL to inventoried FACILITY: Location: 938 FRONTAGE RD— RIPON (Must have FACILITY IDI) ....................................................................._............-..................-....__........ Complainant: BRUCE,_._MAC.,C0RDL,ESS..........,..-,.,,__....__....................._.......................Horne Phone: Address : _. ..............................._..................._..............._................_....._... ...--......----..................__Work Phone : FACILITY LOCATION/Property Info — DBA or Name : Loc Code Address : BOS Dist City: APN # Phone: BILLING RESPONSIBLE PARTY or OWNER Info — Name: Home Phone: Address: — _ ... . Work Phone: City: Nature of Complaint: 50 GALLONS OF ENZONE ( FUNGICIDE AND INSECTICIDE SPILLED . ALL CLEANED UP BY RP/OWNER COMPLAINT Info — COMPLAINT MODE: -P, A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence 0-Other EH Unit P-Phone COMPLAINT STATUS: 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated 06-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated Forwarded to UNIT: I II 0 IV for Investigation