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Date: ruA: 03/17/9 5AN JOAOUIN COUNTY PUBLIC HEALTH SERVIC Report 15104 <br /> Run by : LAURIE C, Page # 6 <br /> Copy # :. 01 of ESI CLAINT INVESTIGATIONREPORT <br /> �lf�YRNFf <br /> !' <br /> NOW9.0. <br /> � <br /> llslT 0 = C0007865 Program/Element / <br /> Tai n by : 8114 WY FRWS Date: 43/17/97 Aseipled to : 8194 RAIU NTHN Date: 03/17/97 �(o •S <br /> Hard copy hinted: 03/17/97 <br /> Facility Name: Fac ID: 00Y(0LlI <br /> BILL to inventoried FACILITY: <br /> Location: 4555PERSHING (Must have FACILITY Imo) <br /> Complainant: NINON —_____Home Phone:. <br /> Address: — _._ – _ _ _Work Phone: <br /> FACILITY LOCATION/Property Info <br /> DBA or Name: STOCK7C1�1 R4C5 Loc Code : <br /> Address: 4 a5 A BOS Dist = <br /> City: , 5_TOCKTON APN #—� <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info <br /> Name:. Home Phone: <br /> Address: . Work Phone: <br /> City: <br /> Mature of Cogaint: <br /> SAT 3/15/97 TOILETS BACKED UP & URINE ON THE FLOOR, ALSO NO PAPER <br /> TOWELS IN LADIES ROOM. <br /> CQMP"INT Info — <br /> CONPLAINT W: P PHN <br /> A-Apency Referral B-8D OF Svpervisors/CitY Ccovacil C-Counter Neil/Cerrap"desce <br /> O-Other EH Nnct P-Pbw <br /> CDWUIKT STATUS: <br /> O1441d Abated 02-0ffice mated 03-Ml $tot 04-Not' Issued 45-E)vforce ACT Initiated <br /> 05-Transfer to Precise File 07-Refer to 0ther Apncy -Kat slid 09-Foodborne 1111488 <br /> Circle appropriate Unit 1 if coeplaint In aAother PROGRAK ,jurisdiction, Have Complaint Record and P/E updated <br /> Foriarded to UNIT: (,�} 11 111 IV for Investigation <br />