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A10A). '7 / U 61 SHORT-TERM COMPLAINT <br /> Taken By 73-5-qComplaint <br /> � <br /> Date . <br /> 27 Program l 4U Facility IO# <br /> Premise 7 7.6, <br /> DBA <br /> i <br /> Owner/Operator C,��J Phase ( ) <br /> Address 7Cp.z -4 City state, (fA Zip . yS 33 <br /> Complainant's N; ne Phone ( ? <br /> Address City Zlp <br /> G <br /> Nature t Co pfa rrt <br /> --------------- <br /> DBA or Name: Loc Cade 9 <br /> Address: BOB Dist : .005 <br /> City; AP" 0 <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or LMER Info - <br /> Name: MARTIN TEUNIgSEN Home phone: <br /> Address: ?752 E WEST RIPON ROAD Work Phone: <br /> City: RIPON CA 95337 <br /> Nature of Complaint: <br /> SUBSTANDARD HOUSING 1 <br /> M <br /> i <br /> I t <br /> COMPLAINT Info - I <br /> COMPLAINT MODE: A AGENCY REFERRAL <br /> r <br /> A-.Agency Referral B-BD OF Supervisers/City Ccouneil C-Counter M-Mail/Correspondence <br /> O-Other EH Unit P-Phone � <br /> COMPLAINT STATUS, D <br /> 01-Field Abated 42-Office Abated Q3-NAI Sent 04-Notice to Abate Issued 05-Enforce f_ ACT initiated i <br /> 06-Transfer to Premise file 01-Refer to Other Agency 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit 0 if complaint in another PROGRAM Jurisdiction, Have Gmmplaj!'?t RE'r-nrrl and PfE updated <br /> i <br /> 4 <br />