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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000035780 Site Location: 1172 N MAIN ST <br /> Account 1D.- AR0001854 <br /> Received by: EE0004636 BACKUS <br /> Received date: 12/19/2012 Print Date: 12/19/2012 4:09:37PM <br /> Assigned To: EE0004636 BACKUS Assigned Date: 12/19/2012 <br /> Prooram/Element Co 2200-HAZARDOUS WASTE GENERATOR PROGRAM <br /> Complainant: :NONE-RECORDING TIME PURPOSES Nome Phone <br /> Address Work Phone <br /> -Mail Address <br /> Nature of complaint: <br /> P57STER SEARCH <br /> Complaint Mode: Q Complaint Mode Codes A-Agency Referral B-Bd of Supervisors!City Council C-Counter F-Fax <br /> IE-Code Enforcement M-Mail 1 Correspondence O-Other EH Unit P-Phone <br /> I-Internet 1 Email S-Sheriff's Office <br /> ------------------------------- - ----- <br /> FACILITY <br /> ----- ---- ---- ---- ---- ---- - ------ <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0000833-S-MART #386 Owner: OW0000369-SAVE.MART <br /> Site Location 1172 N MAIN ST RP/DSA : <br /> MANTECA,CA 95336 RPAddress 1800 STANIFORD AVE <br /> Cross Street MAIN MODESTO,CA 95350 <br /> r <br /> Mailing Address: PO BOX 4664 Billing Address PO BOX 46664 <br /> MODESTO,CA 953524664 MODESTO,CA 94551-464 <br /> Home Phone :209-574-6299 EXT: 1 I I <br /> i Phone :209-239-2276 Work Phone <br /> District Location Code <br /> APN <br /> ^——Date Abated l7 Inspector ID#:— -- ---p-- - I— G ------- ------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: G L <br /> Circle appropriate Status Code w <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02-OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 03-NAI SENT 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 04-NOTICE TO ABATE ISSUED 50-LEAD Assessment Performed-No Abatement Required <br /> 05-DA-ENFORCEMENT ACTION INITIATED 52-LEAD Abatement Reqired-See Program Record File <br />! 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> f 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL ase Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br />! <br /> i <br /> i <br /> I <br /> } <br />{ dddLF <br /> 5104.rpt - ` <br />