Complaint - Template

	Name
Select	JEFFERSON COUNTY HEALTH CENTER
Select	JEFFERSON CO HEALTH CENTER
Select	Dan Miller
Select	CARL A. NELSON & COMPANY
Select	JEFFERSON COUNTY HOSPITAL
Select	JEFFERSON COUNTY HOSPITAL
Select	LARRY MITCHELL
Select	HIGHLAND PLAZA LLC
Select	Jefferson County Hospital
Select	JEFFERSON COUNTY HOSPITAL

Complaint ID - 22954

Jefferson County Health Center - 310202072

2000 S MAIN ST Fairfield, IA 52556

Jefferson County

FO 6

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Complaint ID:

22954

Date Received:

Date Assigned:

Received By:

Assigned To:

Complainant

Anonymous

DNR Observation

Name:

(F)

(L)

Address:

Phone:

Ext.

Email:

City\State\Zip:

Statement of Complaint:

Complaint Type:

Complaint Location

Sec:
Tier:
Range:
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Complaint Resolution

Action Date:

Status:

Compliance Determination:

Responsible Party

Report

Attached Files/Reports

Document Name	Type	File Date	Note
Fairfield Water Jefferson County Hospital Complaint 6-2-16.pdf	Letter (public)	06/02/2016	Fairfield Water Jefferson County Hospital Complaint 6-2-16.pdf

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
12/2/2016	NOTE: There is additional information in the Fairfield Municipal Water Supply File regarding this complaint.	AARON PICKENS
8/4/2016	Visited on June 2, 2016. Visit memo is attached.	AARON PICKENS

Comment:

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

Multiple Results Found

Field Office Compliance - Complaint

Complaint ID - 22954

Jefferson County Health Center - 310202072

2000 S MAIN ST Fairfield, IA 52556

Jefferson County

FO 6

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