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Complaint Investigation Form <br /> Report A5104 <br /> COMPLAINT ID: 0036327 Site Location: 6425 PACIFIC AVE Account 1D: <br /> Racenredbw EE0006044 ALLEN Received Date: 4/26/2013 <br /> Assigned to: EE0001421 RIVERA Print Date: 4/26/2013 2:52:40PM <br /> Assigned Date: 4/2612013 <br /> Prngram/Element Cnr,�-2546_Release Response Day <br /> Complainant: :CHRIS-VEDEROOT <br /> Phone <br /> Address Home Ph • <br /> Work Phone <br /> -Mai!Address <br /> Nature of complaint: <br /> 2 GALLONS OF GASOLINE WAS SPILLED <br /> Complaint Mode: A __ <br /> 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 /> 1-InternetI Email S-Sheriffs Office <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner:SAFEWAY <br /> Site Location 6425 PACIFIC RP/DBA <br /> STOCKTON,CA 95207 RPAddress <br /> Cross Street • <br /> Billing Address <br /> Nome Phone <br /> Phone Work Phone <br /> District 001-VILLAPUDUA Location Code 01-STOCKTON <br /> APN <br /> Date Abated Inspector 1D <br /> Send Referral to Referral Letter Sent by r <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 01-FIELD ABATED 16-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 202OFFICE ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 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 /> 07-REFERRED TO OTHER AGENCY 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARDIUNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rpt <br />