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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID. 000035708 Site Location: 1172 N MAIN ST Account ID: AR0001854 <br /> Received by: EE0004636 BACKUS Received Date: 11/27/2012 Print Date: <br /> 11!2712012 9:41:22AM <br /> Assigned To: EE0004636 BACKUS Assigned Date: 11/27/2012 <br /> Provram/Plemen(Code 2200-HAZARDOUS WASTE GENERATOR PROGRAM <br /> Complainant: :ANON Nome Phone <br /> Address : Work Phone <br /> Mail Address <br /> Nature of com taint_ <br /> DUMPSTER SEARCH AT LOVELACE TRANSFER STATION <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 1 Correspondence O-Other EH Unit P-Phone <br /> 1-Internet 1 Email S-Sheriff's Office <br /> -- ---- — <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000833-S-MART #386 Owner: OW0000369-SAVE MART I <br /> Site Location 1172 N MAIN ST RP/D8A <br /> MANTECA,CA 95336 RPAddress 1800 STANIFORD AVE <br /> Cross Street MAIN MODESTO,CA 95350 <br /> Mailing Address: PO BOX 4664 Billie Address <br /> Billing PO BOX 4664 <br /> MODESTO,CA 953 52 4664 MODESTO,CA 94551--464 <br /> Home Phone :209-574-6299 EXT: 111 <br /> Phone :209-239-2276 Work Phone <br /> District 003-BESTOLARIDES Location Code 99-UNINCORPORATED AREA i <br /> APN 21321010 <br /> Date Abated — 'L r It Inspector ID <br /> Send Referral to Referral Letter Sent by — <br /> Referral Address Date: <br /> Complaint Status Code: <br /> i <br /> Circle appropriate Status Code <br /> i <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# k <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> i <br /> j 06-EHE)FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTAN DARDIU N SECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> i <br /> 5 7 04.rpt <br /> s <br />