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r <br /> 'Dfe� run : 03/02/95 SAN 70AGUIN COUNTY PUBLIC HEALTH SERVIC Report 05104 <br /> Ruts by : SHELLYrVr Page # 3 <br /> copy # : 01 of 41 COMPLAINT INVESTIGATION REPORT <br /> COMPLAINT # C0003407 Program/Element : 1600 <br /> Taken by : 0526 SHELLY PRATER Date: 02/24/95 Assigned to : 0369 %rllll� Date.: 02/24/95 <br /> Hard copy Printed: <br /> Facility Name: FODD._..4..._l SS.. Fac ID: 0024+63 <br /> BILL to inventoried fACILiTY: <br /> Location: 67.8.-... W,IL.S.P.N...WAY, (Must have FACILITY IDR) <br /> Complainant= <br /> <br /> : <br /> FACILITY LOCATION/Property Info - <br /> DBA or Name: ........ Loc Code <br /> Address ' ...... ....-.. ...... ............................... .............__ ....BOS Dist <br /> City = ... <br /> APN # : <br /> Phone: <br /> BILLING RESPONSIBLE PARTY or OWNER Info - <br /> Name : Horne Phone; <br /> Address : Work Phone: <br /> ............................._._...............-.._....._....................... <br /> City ,- ...._ <br /> Mature of Complaint: si ("> __ rY-\ (1_M! n ; Z,ZCk,, <br /> Cor no s � . 3 o5h,5 <br /> R <br /> COMPLAINT Info - <br /> COMPLAINT MODE: ... <br /> A-Agency Referral B-BD OF Supervisors/City Ccouncil C-Counter M-Mail/Correspondence <br /> 0-0 Unit P-Phone <br /> COMPLAINT STATUS: <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 08-Not Valid 09-Foodborne Illness <br /> Circle appropriate Unit 4 if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br /> Forwarded to UNIT: n II III IV for Investigation <br />