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s s' Complaint Investigation Form Report#:5104 <br /> 60MPLAINT ID: C00020337 Site Location: 18007 MACARTHUR DR Account ID: <br /> Receivedby: EE0000321 OLIVEIRA Received Date: 1/30/2004 Print Date: 2/5/2004 4:30:44PM <br /> Assigned To: EE0005838 ELLSAESSER Assigned Date: 1/30/2004 <br /> Program/Element Code-4600-PUBLIC WATER SYSTEM PROGRAM <br /> Complainant: :DAVID FRANCKOWIAK Home Phone <br /> I <br /> Address Work Phone :2t)9-830-8904 <br /> h <br /> I <br /> i <br /> Nature of complaint: <br /> FACILITY SERVING CONTAMINATED WATER,(C)SICK FROM WATER SERVED FROM CONTAINER AT THE THIRD HOLE.THERE MAY BE NO <br /> DOMESTIC WELL, ONLY IRRIGATION WELL PERMIT ON FILE.MAY BE OPERATING PWS WITH OUT A PERMIT. PLEASE CALL COMPLAINANT <br /> BACK AFTER INSPECTION. M <br /> Complaint Mode: P Complaint Made Codes A-Agency Referral B-Bd of Supervisors/City Council C-Counter <br /> E-Code Enforcement M-Mai]t Correspondence O.Other EH Unit P-Phone <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION ; <br /> I � <br /> Property Name: Responsible Party or Property Owner:OLD RIVER GOLF CLUB <br /> Site Location 18007 MACARTHUR RP/DBA <br /> TRACY,CA RP Address <br /> I� <br /> Billing Address <br /> Home Phone ,f <br /> Phone Work Phone <br /> 1 <br /> District Location Code <br /> APN <br /> Date Mated 2 � Oj Inspector. Q�q5 <br /> ----------------- _._— -- ------------------ I' -- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> I <br /> Complaint Status Code: 6 <br /> Circle appropriate Status Code <br /> IELD ABATED 14-E��ssN�KO,RCEMENT CASE-Transferred to ER FILE <br /> 02-OFFICE ABATED 15_AC�VE 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 /> 06-EHD PERMIT FACILITY-see Linked PROGRAM FACILITY FILE 19-ENFOtCEMENT CASE-Transferred to WELL PROGRAM FILE <br /> 07-REFERRED TO OTHER AGENCY 28-FOODBORNE ILLNESS-Unconfirmed Complaint History! <br /> 08-UNABLE TO VERIFY 9-FOODBORNE ILLNESS-Confirmed Attached But Not <br /> 09-FOODBORNE ILLNESS 50'-LEAD <br /> 1 AZ EVALUATION±REQUIRED(1) Scanned <br /> 10-SUBSTANDARD PROPERTY-SEE HOUSING ABATEMENT FILE 511 LE A' &,W RK PLAN SUBMITTED(2) <br /> 11-Multiple Complaints-SEE ACTIVE CASE# 52-LEAD HAZ��yyABA�TEMENT IN PROGRESS(3} <br /> 12-ENFORCEMENT CASE-Transferred to LIQUID WASTE FILE 3-L AD HA�-,+I VISUA1_'��IINSPECT SATISFACTORY(4) <br /> 13-ENFORCEMENT CASE-Transferred 10 SOLID WASTE FILE 4-LEAD HAt4� ST EVALUATION SATISFACTORY(5) <br /> I <br /> C0MPLM]vT DESK <br /> COPY <br /> 5104.rpt j <br />