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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00034727 Site Location: 2151 COUNTRY CLUB BLVD AccountiD., <br /> ReaeNBdby: EE0004636 BACKUS Recah`ed Date: 3/13/2012 PdntDate: 3/13/2012 2:56:48PM <br /> Assigned To: EE0004636 BACKUS Assigned Dete: 3/132012 <br /> P r O Ile t Cod 2200-HAZARDOUS WASTE GENERATOR PROGRAM <br /> Complainant: :ANON Home Phone <br /> Address Work Phone <br /> E-Mail Address <br /> Nature of complaint: %J <br /> FACILITY HAS OILY LIQUID STORED IN TOW UNDERGROUND TANKS. <br /> Complaint Mode: P Complaint Mode Codes A-Agency Referral B-Bd of Supervisors/City Councd C-Counter F-Fax <br /> E-Code Enforcement M-Mar/Conespondence 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:2151 COUNTRY CLUB BLVD LLC <br /> Site LO-9- 2151 COUNTRY CLUB RRDBA <br /> STOCKTON,CA RPAddnam PO BOX 1692 <br /> Cross Street NIANTECA,CA 95236 <br /> Billing Address PO BOX 1692 <br /> Home Phone <br /> Phone WM Phone <br /> Dlshict 001-VILLAPUDUA Location Code 99-UNINCORPORATED AREA <br /> APN 12308030 <br /> Date AbatedZ� 1.L Inspector ID#: <br /> G <br /> Send Referral to Referral Letter Sentby <br /> Referral Address Date: <br /> Complaint Status Code.- <br /> Circle <br /> ode:Circle appropriate Status Code <br /> 01-FIELD ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 02-OFFICE ABATED 60-LEAD Assessment Performed-No Abatement Required <br /> 03-NAI SENT 52-LEAD Abatement ReglredSee 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 /> 08-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED.See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE If <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 ®r,)" <br /> 5104.rpt <br />