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Ite r_u, : 10/23/95 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC <br /> :n '1ARYOI Report #5104 <br /> Cop, L of01 COMPLAINT INOEC,—X.ATION REPORT Page # 1' <br /> COMPLAINT #� C0004867 Program/Element : 4200 <br /> Taken by : 9051 MARY OSULLIVAN Date: RV23195 Assigned to 0370 WILLIAM MARCHESE Date: <br /> Hard copy Printed: DO/23/95 <br /> Facility Name : Fac ID : <br /> Location 4316 SECTIO[\ - STQ� BILL to inventoried FACILITY: Nd <br /> _....... ..CK7ON Net have FACILITY ID#) <br /> Complainant : <br /> <br /> <br /> : <br /> rACILITY LOCATION/Property Info – <br /> DBA or Name: <br /> __. —_. ......_...Lor Code : <br /> Address : _.... <br /> ............. <br /> City : <br /> Phone: APN # : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Name: GEN ALB <br /> Horne <br /> Phc <br /> Address: 4327 E. .SI_.CTIOtJ <br /> City: _STOCKTC?Iv rp, Work Phone: <br /> _ <br /> Nature of Complaint: <br /> SEPTIC PROBLEr-r awd CbmPlQ;nf C # yBYb <br /> COMPLAINT Info — <br /> COMPLAINT MODE: P,__.,PHONE <br /> A•-Agency Referral B-BD OF Supervisors/City Ccouncil C-Countar M-Mail/Correspondence <br /> O-Other EH Unit P-Phors <br /> COMPLAINT STATUS: /r 0 <br /> 01 ield Abated 02-Office Abated O3-NAI Sent 04-Notice to Abate Issued OS-Enf� <br /> 5-Transfer to Premise File 07-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> i s!e appropriate Unit # if complaint nether PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: 7 Q II IV for Investigation <br />