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I ). IA r1— Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00043765 Site Location: 19133 LIBERTY RD Account ID. <br /> Receivedby: EE0006219 DUNCAN Received Date: 7(7/2017 Print Date. 7/72017 8:24:56AM <br /> Assigned7o: EE0003973 MCCLELLON Assigned Date: 7/7/2017 <br /> EMMInrElement Code:4400-SOLID WASTE PROGRAM <br /> Complainant: :DUNCAN Home Phone <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> BURIED DEBRIS <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-Intemet/Email S-Shenfrs Office <br /> ------------------------------------- ------------ <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Propggy Oe r.W41'lc*Nf kN t rst <br /> Site location 19133 E LIBERTY RA4;&A- <br /> CLEMENTS,CA 95227 RPAddress <br /> Cross Street C'RMUNT-9-CA 9551 In <br /> Billing Address pQ-BOq"5$ C-�+u(I ) C n � � <br /> Home Phone <br /> Phone Work Phone <br /> l l (Cf <br /> District 004-W INN,CHARLES Location Code 99-UNINCORPORATED AREA <br /> APN 00911011 / Q <br /> Date Abated SA <br /> iJ �/ 1 Inspector ID#: Ma, lQ ww� <br /> � <br /> !/ / —L— —___ —----__----_—_ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: ''L, <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-Field Response-Violations Cited and Corrected 28-Alleged FBI-No Major Violations Identified! <br /> 02-Office Response Only 29-Alleged FBI-Major Violations Identified <br /> 50-LEAD Assessment Performed-No Abatement Required <br /> 52-LEAD Abatement Reqired-See Program Record File <br /> 97-Disaster Planning and Response <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-Referred to Other Agency <br /> 08-Unable to Venty Alleged Complaint MN-EHD Monitoring Status <br /> PO-Permit Issued-Pending Well Installation <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File RS-Resolved-New Well Installed <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> (9DA Referred Complaint-See Program Enforcement Action Form <br />