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} Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00036539 Site Location: 2211 N WILSON WAY Account ID: AR0024356 <br /> Received by: EE0002620 ARAMBULA Received Date: 6/20/2013 Print Date: 6/20/2013 3:41:39PM <br /> Assigned To: EE0003973 MCCLELLON Assigned Date: 6/20/2013 <br /> Program/Element de•4700-WASTE TIRE PROGRAM <br /> Complainant: :ANON Nome Phone <br /> Address Work Phone <br /> -Mai!Address <br /> Nature ofcomplaint: <br /> JACKS TIRE AND OIL IS IMPROPERLY COMPLETING MANIFESTS FOR THIS FACILITY <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 l Correspondence O-Other EH Unit P-Phone <br /> I-Internet!Email S-Sheriff's Office <br /> FACILITY INFORMATION _ — — OWNER INFORMATION — T— <br /> Facility:FA0014332-CONNELL T1RE SERVICE Owner: OW0011383-MATTIOLI,ANTHONY <br /> Site Location 2211 N WILSON WAY RP0BA CONNELL TIRE SERVICE <br /> STOCKTON,CA 95205 RPAddress 148N WILSON WAY <br /> Cross Street STOCKTON,CA 95205 <br /> Mailing Address. 1537 E MARKET ST Billing Address 1537 E MARKET ST <br /> STOCKTON,CA 95205 STOCKTON,CA 95205 <br /> Home Phone <br /> Phone ;209-465-1365 work Phone <br /> District Location Code <br /> APN <br /> Date Abated & a,f3_t3 Inspector ID#. AA6:.rel/)7 �l 1J L d. <br /> r [" --_ — __-------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code:oz_ <br /> Circle appropriate Status Code <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 00� FIELD ABATED 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 02- FFICE 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 Regired-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 /> OB-UNABLE TO VERIFY CL-Case Closed <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 5104.rp1 <br />