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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00049310 Site Location: 10948 S AIRPORT WY Account ID: <br /> Received by: EE0009830 SAUERS Received Date: 3/15/2019 Print Date: 3/15/2019 2:17:17PM <br /> Assigned To: EE0000036 SAHOTA Assigned Date: 3/15/2019 <br /> Program/Element Code 4600-PUBLIC WATER SYSTEM PROGRAM <br /> Complainant: <br /> <br /> <br /> !Nature of complaint: <br /> COMPLAINANT ALLEGES THEY HAVE POSSIBLY CONTRACTED LEGIONELLOSIS FROM WELL WATER SYSTEM. <br /> Complaint Mode: A 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 /> --- ----------------------------------------------- <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION <br /> Property Name: RP DBA <br /> Site Location 10948 S AIRPORT WAY RP mailing address <br /> MANTECA,CA 95336 <br /> Cross Street FISK <br /> Mailing address RP contact <br /> RP contact phone <br /> Phone <br /> Property Owner:CENTRAL VALLEY BAPTIST CHURCH <br /> DBA <br /> Owner address <br /> Billing Address 10948 S AIRPORT WAY <br /> MANTECA,CA 95336 <br /> Home Phone <br /> Work Phone <br /> District 003-PATTI,TOM Location Code 99-UNINCORPORATED AREA <br /> APN 20402004 <br /> Date Abated ! f Inspector ID#: Nsp <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: 08 <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 29-Alleged FBI-Major Violations Identified <br /> 02-Office Response Only 50-LEAD Assessment Performed-No Abatement Required <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 52-LEAD Abatement Reqired-See Program Record File <br /> 07-Referred to Other Agency 97-Disaster Planning and Response <br /> E3 Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File MN-EHD Monitoring Status <br /> 11-Multiple Complaints-SEE ACTIVE CASE# PD-Permit Issued-Pending Well Installation <br /> 12-DA Referred Complaint-See Program Enforcement Action Form RS-Resolved-New Well Installed <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 28-Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> AAA <br /> '0111pl= <br /> evieweG y:, �r pate y: ate <br /> 5104.rpt <br />