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Complaint Investigation Form Report 9:5104 <br /> COMPLAHV <br /> VY C00022120 Site Location: 10878 N HY 99 Account 1D: AR0001144 <br /> Received by: EE0003580 LE Received Date: 1/3/2005 Print Date: 1/21/2005 9:01ZAM <br /> Assigned To: EE0003580 LE Assigned Date: 1/21/2005 <br /> Program/Element Code: 300-UNDERGROUND TANK PROGRAM - <br /> Complainant. :MICHELLE LE Nome Phone <br /> Address Work Phone :209-468-9847 <br /> Nature of complaint., <br /> RECEIVED FALSIFIED TEST RESULTS FOR DESIGNATED OPERATOR. <br /> Complaint Mode: O ComplaintMode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counter <br /> E-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> ----------- ------------- ------ <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0001146-MORADA CHEVRON FAST N EASY 060 Owner: OW0000885-ALI,ASHRAF <br /> Site Location 10878 N HWY 99 RP/DBA MORADA CHEVRON FAST N EASY#60 <br /> STOCKTON,CA 95212 RP Address 20 TWELVE OAKS DR <br /> PLEASANTON,CA 94566 <br /> Mailing Address: 6840 GOODYEAR RD STE#C Billing Address 6840 GOODYEAR RD STE#C <br /> BENICIA,CA 94510 BENICIA,CA 94510 <br /> Nome Phone :925-461-9999 <br /> Phone :209-931-6154 Work Phone :209-931-6154 <br /> District 004-SEIGLOCK,JACK Location Code 99-UNINCORPORATED AREA <br /> APIV 08607002 <br /> r <br /> 31� t <br /> Date'Abafed —�� 2 Inspector: 10 1 <br /> —————————————————--— ---———————— <br /> Send Referral to Referral Letter Sent by I <br /> Referral Address Date: <br /> Complaint Status Coder <br /> I <br /> Circle appropriate Status Code <br /> 01-FIELD ABATED 14-ENFORCEMENT CASE-Transferred to ER FILE <br /> 02-OFFICE ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 03-NAI SENT 16-LETTER SENT TO TENANT <br /> 04-NOTICE TO ABATE ISSUED 17-15 DAY LETTER SENT <br /> 05-ENFORCEMENT ACTION INITIATED 18-ENFORCEMENT CASE-Transferred to VECTOR CONTROL FILE <br /> I <br /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFORCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 20-ENFORCEMENT CASE-Transferred to UIC PROGRAM FILE <br /> I <br /> 08-UNABLE TO VERIFY 28-FOODBORNE ILLNESS-Unconfirmed <br /> 09-FOODBORNE ILLNESS 29-FOODBORNE ILLNESS-Confirmed <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 50-LEAD HAZ EVALUATION REQUIRED(1) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 51-LEAD HAZ WORK PLAN SUBMITTED(2) <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 52-LEAD HAZ ABATEMENT IN PROGRESS(3) Q s <br /> 13-ENFORCEMENT CASE-Transferred to SOLID WASTE FILE 53-LEAD HAZ VISUAL INSPECT SATISFACTORY(4) <br /> i <br /> i <br /> 1 <br /> I <br /> complaint History <br /> Attached But Not <br /> Scanned <br /> 5104.rpt <br />