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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00043764 Site Location: 19133 LIBERTY RD Account ID: AR0046296 <br /> Received by: EE0004636 BACKUS Received Date: 7/7/2017 Print Date: 5/7/2019 1:41:03PM <br /> Assigned To: EE0000031 FLORIDO Assigned Date: 6/20/2018 <br /> Program/Element Code 2200-HAZARDOUS WASTE GENERATOR PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> SPILLED OIL. HAZARDOUS WASTE <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/Email S-Sheriffs Office <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Property Name: RPDBA ANDRES GOMEZ <br /> Site Location 19133 E LIBERTY RD RP mailing address <br /> <br /> <br /> <br /> <br /> Phone <br /> Property Owner:ANDRES&OLGA GOMEZ <br /> DBA <br /> Owner address <br /> Billing Address 179 BISMARK ST. <br /> DALY CITY,CA 94014 <br /> Home Phone 415-900-7813 <br /> Work Phone <br /> District 004-WINN,CHARLES Location Code 99-UNINCORPORATED AREA <br /> APN 00911011 nn <br /> Date Abated 511 12019 Inspector ID#: 00-0( ' FLOO w <br /> ------------------------------------- -- ------------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code ,/' <br /> 1 Field Response-Violations Cited and Corrected je e SGl l Gl WASE 29-Alleged FBI-Major Violations Identified <br /> 02-Office Response Only l P09 50-LEAD Assessment Performed-No Abatement Required <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 52-LEAD Abatement Reqired-See Program Record File <br /> 07-Referred to Other Agency 97-Disaster Planning and Response <br /> 08-Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File MN-EHD Monitoring Status <br /> 11-Multiple Complaints-SEE ACTIVE CASE# PD-Permit Issued-Pending Well Installation <br /> 12-DA Referred Complaint-See Program Enforcement Action Form RS-Resolved-New Well Installed <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 28-Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> omp aint Reviewedte: pate y: at . <br /> 5104.rpt <br />