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W/ Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: 000040629 Site Location: BYRON RD Account ID <br /> Receivedby: EE0008709 DE LA ROSA Received Date: 10/30/2015 Print Date: 11/3/2015 2:20:22PM <br /> Assigned To: EED008709 DE LA ROSA Assigned Date: 10/30/2015 <br /> PProammrE/ement Code:2546-Release/Spill Response(excluding Joint Team) <br /> Complainant: :ANDREA-STOCKTON CHP Home Phone : 209-943-8600 <br /> Address :3330 N AD ART Work Phone <br /> STOCKTON,CA 95391 E-Mail Address <br /> Nature of complaint: <br /> 1 GALLON LATEX PAINT SPILL IN#2 LANE BYRON RD/MOUNTAIN HOUSE.CHP LOG#273 <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Internet/Email S-Sheriff's Office <br /> -- - ------------------ ---------------------------- - <br /> PROPERTY <br /> . - -- —_--- ------ _ -- — ------------------ _PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Patty or Property Owner <br /> Site Location BYRON RP/DBA <br /> MOUNTAIN HOUSE,CA 95391 RP Address <br /> Cross Street <br /> Billing Address <br /> Home Phone <br /> Phone Work Phone <br /> District Location Code <br /> APN <br /> Date Abated Iz?)-I5 Inspector ID#: O ` <br /> ————__—1 —cam——————————————— ———————— — — — —_—— <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFIC ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompainl Reviewed by. rale:' 1. ` Updated by. <br /> 5104.rpt 11 J F7 <br />