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Complaint Investigation Form Report# 5104 <br /> COMPLAINT ID: b00044468 Site Location: 7553 W CARMELOA <br /> Account ID: <br /> Print Date: 91212017 11:07:13AM <br /> Receivedby: EE0000035 HERNANDEZ <br /> Received Date: 2/11/7993 <br /> Assigned To: EE0000753 NG Assigned Date: 9/21/2017 <br /> pmoramrElement Code9600-FOOD PROGRAM <br /> Complainant: :BEVERLY CIRALSKY,(MANAGER PAUL WITNESS,WORK#IS HIS#) Home Phone : 209463-8055 <br /> Address .6625 EAST OAK APT 143 Work Phone :209-948-5203 <br /> E-Mail Address <br /> Nature of complaint: <br /> COMPLAINT WAS FOUND AND ALLEGES"PEOPLE PAY$12.00 AYEAR AND RECEIVE FOOD IN PAPER SACKS DELIVERED BY TWO LADIES <br /> MOLDYAWITH SLIME"ORIGINAL COMPLAINT#930215 0ON 2D IS 2/11/93.GIVEN ENVISION COMPLAINT NUMBER TO HAVEN DATA BASE OLDON THE 2NO AND 4TH WEEK OF EACH MONTH.FOOD IS AND <br /> FUTURE REFERENCE) <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/Couespondence O-Other EH Unit P-Phone <br /> 1-Intemel/Email S-Sheriffs Office ____ <br /> PROPERTY OWNER INFORMATION <br /> PROPERTY INFORMATION <br /> Property Name: Responsible Party or Property Owner:GOOD SAMARITAN COMMUNITY <br /> Site Location 7553 W CARMELOA RP/DBA GOOD SAMARITAN COMMUNITY <br /> TRACY,CA RP Address 7553 W CARMELOA <br /> Crass Street ACAMPO,CA <br /> Billing Address 7553 W CARMELOA <br /> Home Phone : <br /> Phone Work Phone -2112 <br /> District Location Code <br /> APN <br /> Date abated ,y,_��j Inspector ID#: N 61 <br /> — — _ ----- <br /> Send Referral to Referral Letter Sent by <br /> Date: <br /> Referral Address <br /> Complaint Status Code: (9) <br /> Circle appropriate Status Code <br /> V, <br /> Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> V <br /> 52-LEAD Abatement Regired-See Program Record File <br /> 02-Office Response Only <br /> 97-Disaster Planning and Response <br /> 0e-Violations Cited-see Linked PROGRAM FACILITY FILE <br /> 99-UNSPECIFIED-OS Complaint-No Original Found <br /> 07-Refferred to Other Agency <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> PD-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form 51-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations identified <br /> ate' =by <br /> ompamt Reviewedy: -Ol-�a--ti <br /> 5104.rpt <br />