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Date run= 07/21/07 '"SAN .7nAQ(.1TN COUNTY PI_IE3LIC HEALTH SERVIC Report #5104 <br /> Run by: r,AROLDPage 4 <br /> copy # 01 of &Y �,.,MPLAINT INVESTIGATION REPG., <br /> COMPLAINT # = COOO8637 Program/Element :`j,©O <br /> Taken by : 3304 ARMSTRONG Date: 07/21/97 Assigned to 0794 MATHEW Date: 07/21/97 <br /> Hard copy Printed: <br /> F,--iril. ity Name - Fac ID : <br /> BILL to inventoried FACILITY:. <br /> Location= FSS N . PERSHING AVE qTnrk:Tnl\l (Must have FACILITY I0#) <br /> Comdr 1 a i na nt - TFSSTF MAGAI_I-ANF Home Phone. : <br /> Address - Work Phone ' <br /> Z <br /> FACILITY LOCATION/Property Info — <br /> DRA or Name - Loc Code : <br /> AdrlrhG; ROS Dist : <br /> APN H. <br /> BILLING RESPONSIBI_F PARTY or OWNER Info — <br /> �1am Home Phone: <br /> Ir!r Work Phone ! <br /> r ; t . <br /> r�rr,nr r-MTt,I^TTr1 7 P n M fel IM'-' TSI Pnr_I:' <br /> Al <br /> COMPLAINT Infer- <br /> CnMDIAINT mnnE: f cHONF <br /> A-Agency Referral 8-9D OF Supervisors!City Ccouncil C-Counter M-Mail!Correspondence <br /> O-Other EH Unit P-Phone <br /> COMPLAINT STQ,THI : 01� <br /> ^1-7ield Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> O6-Transf-r to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Send Referral Letter to: <br /> Address: <br /> Refer rat Letter Sent bY : _.._ _ Date = <br /> "irCle appropriate Unit 9 if Comvlaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: Q II III IV for Investigation <br />