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pate.yrun: 10/16/97 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 55104 Run by : CAROLDr Page # 1 Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT COMPLAINT # = C0009195 Program/Element : 4000 Taken by * 6519 DISA Date: 10/16/97 Assigned to : 0794 MATHEW Date: 10/16/97 Hard copy Printed: Facility Name: .......__. Fac ID: BILL to inventoried FACILITY: Location: 4555.....N_.....PERSH _NG......AVEn (Must have FACILITY ID#) Complainant: DR,.,,..,..._. oHN,_VAN....-.................................................__............__......_.._.............................Home Phone: 209-951-9715 Address: Work Phone: FACILITY LOCATION/Property Info — 3 DBA or Name ...................... ....Loc Code : Address: E30S Dist : City: APN # Phone : BILLING RESPONSIBLE PARTY or OWNER Info — Name' ...... ..._...................._...._............_._._._..__._...._......._........_...._....__...._._._._.__. .. Home Phone; Address" _............ _ ...._..................._.._......_..........................._._...._...._............_.........._._...._. .......__._. -_....__._...........Wa r k Phone : City= Nature of Complaint: EXCESSIVE AMOUNT OF FLIES AND LARVA FROM DUMPSTER IN BACK CANNOT KEEP FLIES OUT OF OFFICE . 3 COMPLAINT Info — COMPLAINT MODE: P PHONE A-Agency Referral B-80 OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence 0-Other EH Unit P-Phone COMPLAINT STATUS: O 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 Send Referral Letter to: Address: Referral Letter Sent by : Date: Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated Forwarded to UNIT' IQ II III IV for Investigation 'I