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Date run: 10/05l99R SAN JOA(UIN COUNTY PUBLIC HEALTH SERVIC Report #5104 Run by : CAROLD Page # 1 COPY # : 01 of 01 COMPLAINT INVESTIGATION (DEPORT ,.,....,.,.a.,,.., .,e.,n.,n.,.anrnrnrtrrnna COMPLAINT # : C0013074 Program/Element Taken by : 5366 LINEBAUGH Date: 1 5 9 Assigned to : 5366 LINEBAUGH Date: 10/05/99 Hard copy Printed: l Facility Name. ............ac ID: i BILL to inventoried FACILITY: Location: 3009.,_..S.,.__POC.K......L-N (Must have FACILITY I00) Complainant: Address: FACILITY LOCATION/Property Info — DBA or Name: Loc Code_: ..._....................Y........................................._._.___._._................................_.................................._._....._......._.__..._..,.............__........................... Address: 3449......5,..-i"OCK._._k*N..........._._.................................................__._...._._..._._._.........................................BO5. Dist City: S;TO,CKTQN, APN # Phone: BILLING RESPONSIBLE PARTY or OWNER Info - Name". ...... ................_._....._...................................._.._......_...._._._........._......._....._......_......_............. Address: .......... ......... .... ....._.......... ___ ..... ............. .... _...................... .................. _......_............. ... .._ City: Nature of Complaint: OPEN, UNSECURED SFD AND BASEMENT. COMPLAINT Info -- COMPLAINT MODE: P PHONE A -Agency Referral B -BD OF Supervisors/City Ccouncil C -Counter 0 -Other EH Unit P -Phone COMPLAINT STATUS: Home Phone: Work Phone: M-Mail/Correspondence 01 -Field Abated 02 -Office Abated 03 -NAI Sent 04 -Notice to Abate Issued 05 Enforce ACT Initiated 06 -Transfer to Premise File 07 -Refer to Other Agency 06 -Not Valid 09 -Foodborne Illness Send Referral Letter to: Address: Referral Letter Sent by: Date:_ Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated Forwarded to UNIT: 0 11 III IV for Investigation