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C� Complaint Investigation f=orm Report#:5104 <br /> rl <br /> COMPLAINT ID: C00033153 Site Location: 901.5 W WALNUT GROVE AccountlD.- AR0025117 <br /> Receivedby: EE0005366 MEDINA Received Date: 2/7/2011 Print Date: 21712911 2:33:46PM <br /> Assigned To: EE0005366 MEDINA Assigned Date: 2/7/2011 <br /> Program/Element Code:4200-LIQUID WASTE PROGRAM <br /> Complainant: :LISA MEDINA, EHD Nome Phone <br /> Address Work Phone <br /> E-Mail Address <br /> r <br /> Nature of complaint.- z <br /> SURFACING EFFLUENT OBSERVED AT FILTER BED AREA(S). <br /> Complaint Mode: .O Complaint Mode Codes A-Agency Referral B-Bd of Supervisors 1 City Council C-Counterz `F-Fax. <br /> r.=-Code Enforcement M-Mail!Correspondence O-Other EH Unit P-Phone <br /> k I-Internet!Email S-Sheriff's Office <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0014762-THORNTON CHEVRON Owner: OW0011767-JD SINGH SERVICE STATIONS,INC <br /> Site Location 9015 W WALNUT GROVE RP/DBA <br /> r, <br /> THORNTON,CA 95656 RP Address 2410 TECADO TERRACE R+ <br /> Cross Street FREMONT;CA 94539 P <br /> c Mailing Address: 44301 HUNTER TERRACE Billing Address 2410 TECADO TERRACE <br /> FREMONT,CA 94539 FREMONT,CA 94539 <br /> kk <br /> Nome Phone :209-794-8993 r <br /> Phone :209-794-8993 Work Phone <br /> District 004-VOGEL,KEN Lo tion Code 99-UNINCORPORATED AREA <br /> APN 00114040 <br /> Date Abated p�j���j lnspec <br /> A w <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: I <br /> �r <br /> Complaint Status Code: Qv c <br /> Circle appropriate Status Code <br /> 01 FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED <br /> 52-LEAD Abatement Regired-See Program Record File ! <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPEC€FIED-Old Complaint-No Original Found <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <br /> 08-LINABLE TO VERIFY <br /> € 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> i 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form I� <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# ? <br /> 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> i 29-FOODBORNE ILLNESS-Major Violations Identified ' <br /> 51 W.rpt <br /> ,, j <br />