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,. Complaint Investigation Form Reportk 5104 <br /> COMPLAINT ID: C00033848 Site Location: 7939 W 11TH ST Account ID: AR0002789 <br /> Received by: EE0090753 MARTINEZ Received Date: 711912011 Print Date: 7/19/2011 104:36PM <br /> Assigned To: EE0004045 TASIOPOULOS Assigned Date: 7/1912011 <br /> Program/Element Code.-4200-LIQUID WASTE PROGRAM <br /> Complainant: : <br /> <br /> <br /> i <br /> Nature of com faint: i <br /> (C)STATED SEWAGE IS BACKING UP EVERYWHERE IN THE FACILITY, PARKING LOT,AND ALSO INTO THE OTHER SUITES IN THIS <br /> BUSINESS. (APARTMENT/BUSINESS), <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 1 Email S-Sheriffs Office <br /> ---------------------------------------------------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0003221-JACKS PLACE Owner: OW0002400-MAH,GUEY JACK <br /> Site Location 7939 W 11TH ST RP/DBA JACKS PLACE <br /> TRACY,CA 95376 RP Address 31 E GRANT LINE RD <br /> Cross Street 11 TRACY,CA 95376 <br /> Mailing Address: 7939 W 11 TH ST Billing Address 31 E GRANT LINE RD <br /> TRACY,CA 95376 TRACY,CA 95376 <br /> Nome Phone <br /> Phone :209-832-3392 Work Phone - <br /> District 005-ORNELLAS,LEROY Location Code 99-UNINCORPORATED AREA <br /> APN 25014009 <br /> Date Abated Inspector 1D#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Coder <br /> Circle appropriate Status Code <br /> 45 FIELD ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 03-NAI SENT 52-LEAD Abatement Reqired-See Program Record File <br /> 04-NOTICE TO ABATE ISSUED 97-Disaster Planning and Response <br /> 05-DA-ENFORCEMENT ACTION INITIATED 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 09-UNABLE TO VERIFY <br /> 10-POSTED S UBSTAN DARDIU NSECU RED-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 /> 51 <br /> /rpt ,. <br />