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Bate rL:n : 09/07/94 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report #5104 <br /> RLin by : CAROLINE mage # l <br /> Copy # : 01 of 01 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0002521 Assigned <br /> : 4200 <br /> Taken by : 0102 STEVE MINDT Date: 09/02/94 Assigned to 01 STEVE MiNDT Date: 99102/94 <br /> F=acility Name : — Fac ID: <br /> BILL to inventoried FACILITY: <br /> Location: 202.5.EE WEPER (Must have FACILITY ID#) <br /> Complainant : HAKE:EM,ELLIS tt SIMONELLI Home phone: <br /> Address: Work -Phone . <br /> FACILITY LOCATION/Property Info — <br /> PBA or Name . Loc Code : <br /> Address : BOB Dist : <br /> City - APN # <br /> Phone : <br /> BILLING RESPONSIBLE PARTY or OWNER Info — <br /> Home Phone': <br /> Name : <br /> Address : -- Work Phone : <br /> City: <br /> Nature of Cooplaint: J <br /> 1 / <br /> 3 �q 3 dot f,, g/ 41$ ,` �c <br /> S& C, co , <br /> COMPLAINT Info — <br /> COMPLAINT MODE: <br /> A-Agency Referral B-BD Or Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0--Other EH Unit P-Phones <br /> COMPLAINT STATUS: "' W "r <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued, 05-Enforce ACT Initiated <br /> 06-Transfer to Precise File 07-Refer to Other Agency 6$-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit # if complaint in another PROBRAM jurisdiction, Have Coaplaint Record and PIE updated <br /> Forwarded to UNIT: I I IV for Investigation <br />