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(4{11.1 Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00047559 Site Location: 4219 WATERLOO j-{ ;���auy �tccounrlD: <br /> Receivedby: EE0009488 WONG Received Date: 10/8/2018 Print Date: 10/8/2018 11:46:01AM <br /> Assigned To: EE0009488 WONG Assigned Date: 10/8/2018 <br /> Program/Element Code: 300-WELL PROGRAM <br /> Complainant: : <br /> <br /> Mail Address <br /> Nature of complaint: <br /> ABANDONED WELL BASED ON OUT OF SERVICE WELL PERMIT#90-295. <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/Correspondence O-Other EH Unit P-Phone <br /> 1-Internet/Email S-Sheriffs Office <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner:WATERLOO ENTERPRISES INC. <br /> Site Location 4219 E WATERLOO RPIDBA <br /> STOCKTON,CA 95215 RP Address 4219 E WATERLOO RD <br /> Cross Street HWY 99 STOCKTON,CA 95215 <br /> Billing Address 4219 E WATERLOO RD <br /> Home Phone <br /> Phone Work Phone <br /> District 004-WINN,CHARLES Location Code 99-UNINCORPORATED AREA <br /> APN 08710009 <br /> Date AbatedZ 2 4/zot Inspector ID#. V/0 <br /> ----------------- - -- ------------------------------------------------------------- ---------------------------- ----------------------------------------------------- <br /> Send Referral to Referral Letter S <br /> Referral Address Date: <br /> i <br /> Complaint Status Code ) / <br /> Circle appropriate Status Code <br /> 01- ield Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 1= Office Response Only 52-LEAD Abatement Regired-See Program Record Fite <br /> 06-Violations Cited-see Linked PROGRAM FACILITY FILE 97-Disaster Planning and Response <br /> 07-Refferred to Other Agency 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 08-Unable to Verify Alleged Complaint MN-EHD Monitoring Status <br /> n <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File PD-Permit Issued-Pending Well Installation <br /> 11-Multiple Complaints-SEE ACTIVE CASE# RS-Resolved-New Well Installed <br /> 12-DA Referred Complaint-See Program Enforcement Action Form S1-Tank pumped <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S2-Hooked up to public sewer <br /> 28-Alleged FBI-No Major Violations Identified S3-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> a <br /> f. <br /> omplaint Reviewedy: a e: p a e y: ate: <br /> 2 Zc; --�. 2 <br /> i 5104.rpt <br />