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Complaint Investigation Form Report#.5104 <br /> COMPLAINT ID: COGPIZ9SB Site Location: 16888 MCKINLEY AVE Account ID AR0003421 <br /> Receivedfir EE0000006 SAEED Received Date: 10/24/2015 Print Date: 10/27/2015 8:31:47AM <br /> Assigned To: EE0004636 BACKUS Assigned Date: 10/24/2015 <br /> Program/Element Code 2546-Release/Spill Response(excluding Joint Team) <br /> Complainant :Mike Hyland,Super Store Industries Home Phone <br /> Address : 16888 McKinley Ave Work Phone :209-858-3311 <br /> LATHROP,CA 95330 E-Mail Address <br /> Nature ofcomplaint: <br /> Diesel spill from refrigerated trailer. 5-7 gallons.Trailer collapsed, rupturing the under trailer tank. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> I-Intemet/Email S-Sherifrs Office <br /> ----- ------- - - ------------------------- - ----- <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0003933-Super Store Industries-Grocery Division Owner: OW0002838-Super Store Industries <br /> Site Location 16888 McKinley Ave RP/DBA SUPER STORE INDUSTRIES <br /> Lathrop,CA 95330 RP Address 16888 MCKINLEY AVE <br /> Cross Street MCKINLEY LATHROP,CA 95330 <br /> Mailing Address: P.O.Box 549 Billing Address 2800 W.March Lane <br /> Lathrop,CA 95330 Stockton,CA 95219 <br /> Home Phone <br /> Phone :20M58-3365 EXT: Work Phone . <br /> District 003-BESTOLARmES,STEVE Location Code <br /> APN <br /> Date Abated •L7�t �— Inspector ID It: f?AC4 ^s <br /> ---- - - --------------------------------- ------ <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: e>6 <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <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 Reclined-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 0e-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY MN-EHD Monitoring Status <br /> PD-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 /> 12-DA Referred Complaint-See Violation Tracking Form <br /> ompaint Reviiwied by Date'. pdated by Date'. <br /> L <br /> s,oa.n. <br />