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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00034441 Site Location: 10 W MOSSDALE RD Account ID: <br /> Received by EE0005366 MEDINA Received Date: 12/21/2011 Print Date: 12/21/2011 4:32:26PM <br /> Assigned To. EE0004045 TASIOPOULOS Assigned Date: 12/21/2011 <br /> Program/Element Code-4200-LIQUID WASTE PROGRAM <br /> Complainant. <br /> <br /> <br /> Nature of complaint: <br /> OPEN,ABANDONED SEPTIC TANK AT LID COVER; LOCATED SOUTH OF ABANDONED RESTROOM FACILITY AT OLD MOSSDALE MOBILE <br /> HOME PARK. <br /> Complaint Mode: O 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-Internet/Email S-Sheriffs Office <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner <br /> Site Location 10 W MOSSDALE RP/DBA MOSSDALE MOBILE HOME PARK <br /> LATHROP,CA 95330 RP Address 2264 INDUSTRIAL DR <br /> Cross Street SHERIDAN,WY 82801 <br /> Billing Address 2264 INDUSTRIAL DR <br /> Home Phone <br /> Phone Work Phone <br /> District 005-ORNELLAS,LEROY Location Code 99-UNINCORPORATED AREA <br /> APN 23902001 <br /> Date Abated �c/?�/�y Inspector ID#. <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 0-FIELD ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 03-NAI SENT 52-LEAD Abatement Regired-See Program Record File <br /> 04-NOTICE TO ABATE ISSUED 97-Disaster Planning and Response <br /> 05-DA-ENFORCEMENT ACTION INITIATED 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 5104 pt <br />