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Complaint Investigation Form Report#: 5104 <br /> COMPLAI ID: C00036172 Site Location: 2025 W HAZELTON AVE Account ID: AR0017783 <br /> Received by: EE0001421 RIVERA Received Date: 3/21/2013 Print Date: 3/22/2013 11:57:17AM <br /> Assigned To: EE0001421 RIVERA Assigned Date: 3/21/2013 <br /> ProaramlElement Code:2546-Release Response Day <br /> Complainant: :PHIL SIMON-STOCKTON FIRE Home Phone <br /> Address Work Phone <br /> -Mall Address <br /> Nature of complaint: <br /> A SILp OF FLY ASH WAS OVERFILLED FOR APPROXIMATELY 20 MINUTES,RELEASING THE FLY ASH TO THE GROUND. <br /> Complaint Mode: A Complaint Mode Godes A-Agency Referral B-Bd of Supervisors l City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail f Correspondence O-Other EH Unit P-Phone <br /> I-Intemet 1 Email S-Sheriff's Office <br /> —————————— ——————-------------- <br /> FACILITY <br /> ---- ------- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0010783-HEADWATERS RESOURCES INC Owner: OW0008783-ISG RESOURCES INC <br /> Site Location 2025 W HAZELTON AVE RPIDBA HEADWATERS RESOURCES INC <br /> STOCKTON,CA 95203 RPAddress 951 INDUSTRY DR <br /> Cross Street VENTURA TUKWILA,WA 98188-3413 <br /> Mailing Address: 2025 W HAZELTON AVE Billing Address 2025 W HAZELTON AVE. <br /> STOCKTON,CA 95203 STOCKTON,CA 95203 <br /> Home Phone <br /> Phone :209-469-0625 EXT: 0 Work Phone ' <br /> District : Location Code <br /> APN 14503UQ6 } <br /> Date Abated Inspector ID A, <br /> Send Referral to Referral Letter Sent by j <br /> Referral Address Date: <br /> i <br /> Complaint Status Code: <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 /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Regired-See Program Record File <br /> �D 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 /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />