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. i ComplaintInvestigation Form <br /> Report 4: 5104 <br /> COMPLAINT ID: C00036662 Site Location: 5100 E CLARK DR Account ID: <br /> Received by: EEOD00001 TURKATTE Received Date: 7/16/2013 <br /> Assigned To: EE0002424 VELOSO-CACAPIT Assigned Date: 7/16/2013 Print Date: 7/16/2013 9:OS:OOAM <br /> Program/Element Code,1322-SUBSTANDARD HOUSING <br /> Complainant: :MONTEZUMA FIRE DEPT-ED MARTEL Nome Phone <br /> Address ' <br /> Work Phone - <br /> Mail Address <br /> Nature of Com Taint: <br /> UNSAFE STRUCTURE COMPLETELY BURNED LAST FRIDAY.OPEN SWIMMING POOL-ABANDONED PROPERTY.OTHER ADDRESS IS 5268 E <br /> MARIPOSA RD <br /> Complaint Mode. A Complaint Mode Codes I A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> -Intemet 1 Email S-Sheriff's Office <br /> - ----------- __ __--- --__ <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION — <br /> Property Name: Responsible Party or Property Owner:MARVIN H LIPTON TR ETAL <br /> Site Location 5100E CLARK RP/DBA : <br /> STOCKTON,CA 95215 RP Address 655 MARINERS ISLAND BLVD#302 <br /> Cross Street SAN MATEO,CA 94404 <br /> Billing Address 655MARINERS ISLAND BLVD#302 <br /> j • <br /> Nome Phone <br /> Phone Work Phone <br /> i District 001-VILLAPUDUA Location Code 99-UNINCORPORATED AREA <br /> APN /7922016 1I <br /> Date Abated 7!/5— Inspector ID <br /> ——————— —————— <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> I` Complaint Status Code: /0 <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> i 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 1. 05-DA-ENFORCEMENT ACTION INITIATED F 52-LEAD Abatement Regired-See Program Record File <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 0 -UNABLE TO VERIFY CL-Case Closed <br /> OPOSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rp1 <br />