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Date,srup: 12/08/93 ' SAN-JOAQUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 <br /> Run by SYLVIA Page # 2 <br /> Copy # 01 of 0J.r COMPLAINT INVESTIGATION REPORT <br /> MMMMMMI:HMdfMMMMMMhIMMMMMMMMMMMMMhlMMhfMMMhlMMMMMMbfmMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMAlM R • <br /> COMPLAINT # : 00001149 Program/Element : 4200 r <br /> Taken by : 9903 DOUG WILSON_ Date: 12/08/93 Assigned to : 9903 DOUG WILSON Date: 12/08/,93T'i; is <br /> }{? A <br /> Facility Name: _ Fac ID: <br /> BILL to inventoried FACILITY: <br /> !E <br /> Location: �W RIPOH (Must have FACILITY ID#) - <br /> I ��- E L <br /> <br /> <br /> a - <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name: / El��/-fi�E� Loc.Code : ,05 <br /> Address: ?A _ RIPON SOS Dist 005 <br /> city: -RIPON/h9 F411-1 4e 9sa�i' APN # <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name: Home Phone: { <br /> r <br /> Address: Work Phone: <br /> City: <br /> Nature of Complaint; <br /> - PUMP HOOKED UP TO SEWER DRAIN WHICH PUMPS TO - RIGHT $IDE OF -HOUSE T <br /> 0 THE REAR - r <br /> 7 <br /> r <br /> I <br /> COMPLAINT Info - <br /> COMPLAINT MODE: A AGENCY REFERRAL. <br /> A-Agency Referral B-SD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone <br /> i <br /> COMPLAINT STATUS: Y� <br /> 01-Field Abated 02-Office Abated 03-NAI Sent 04-Notice to Abate Issued 05-Enforce ACT Initiated <br /> 06-Transfer to Premise File 07-Refer to Other Agency OB-Nat Valid 09-Foodborne Illness <br /> Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> F. <br /> Forwarded to UNIT: I II III IV for Investigation <br /> t <br /> 3 <br />