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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00031615 Site Location: 2808 COUNTRY CLUB BLVD Account ID, <br /> Received by: EE0001421 RIVERA Received Date: 2/22/2010 Print Date: 2/22/2010 4:18:30PM <br /> Assigned To: EE0001421 RIVERA AssignedDate: 2/22/2010 <br /> i <br /> Proram/Element Code: 546-GENERATOR RESPONSE 1 CLEAN UP <br /> Complainant: :JASON PATRI4UIN,VEEDER-ROOT Nome Phone <br /> Address :COMPLIANCE <br /> Work Phone _ - <br /> E-Mail Address <br /> Nature of complaint <br /> VEHICLE PULLED ONTO THE SITE AND LEAKED SUBSTANCE ONTO PAVEMENT ONLY. THE SITE CLEANED UP SUBSTANCE USING <br /> ABSORBENT PADS. <br /> _::1 <br /> Complaint Mode: A Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter F-Fax <br /> ——— <br /> ——— E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> ———————— ——— ———— ——— <br /> __ _ ----- <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION w_ — <br /> Property Name: Responsible Party or Property Owner <br /> Site Location 2808 COUNTRY CLUB RP/DBA SAFEWAY STORE#1769 <br /> STOCKTON,CA 95204 RPAddress ATTN MS#6516 TAX F-76 <br /> Cross Street PHOENIX,AZ 85038-9096 J <br /> Billing Address ATTN MS96516 TAX F-76 <br /> Nome Phone <br /> . I <br /> Phone Work Phone i <br /> District 003-BESTOLARIDES Location Code 01-STOCKTON <br /> APN 12118038 <br /> Date Abated O Inspector: <br /> — —— `— <br /> ---------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint History <br /> Complaint Status Code: Attached But Not I <br /> Scanned <br /> e appropriate Status Code <br /> 01- iELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> OFFICE ABATED 52-LEAD Abatement RegiredSee Program Record File <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> 06-EHO FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 29-FOODBORNE ILLNESS-Major Violations Identified <br /> I <br /> r � <br /> 51 4.rpt <br />