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- wReport#_5104 <br /> Complaint Investigation Form <br /> COMPLAINT ID: C00015697 Site Location: 2705 COUNTRY CLUB BLVD .account ID: AR0003410 <br /> Received by: EE0000684 INFURNA Received Date: 3/26/2001 <br /> Assigned To: EE0000418 KITH Assigned Date: 3127101 <br /> ProgramlElement Code: 2301 -UST STATE SURCHARGE <br /> <br /> <br /> Nature of complaint: I: <br /> MTBE GROUND WATER CONTAMINATION INCREASING IN CENTER OF SITE. NEW OWNERSIOPERATORS FOR SITE.QUESTIONABLE A <br /> &B FORMS ARE ACCURATE. REQUEST UST INSPECTION TO VERIFY ID NEW LEAK SOURCE PRESENT. COPY OF REPORT TO UNIT <br /> IV-LOP PLEASE AD CONCLUSION. <br /> Complaint Mode O Complaint Mode Codes: A-Agency Referral B-Bd of Supervisors/City Council il E-Code Enforcement <br /> M-Mail/Correspondence O-Other EH Unit C-Counter P-Phone <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility: FA0002048-USA GASOLINE#835 Owner: OW0006493-PALISADES GAS&WASH I <br /> RP/DBA: USA GASOLINE <br /> Site Location: 2705 COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 RPAddress: 30101 AGOURA CT 200 <br /> AGOURA HILLS,CA 91301-4311 <br /> Mailing Address: 30101 AGOURA CT,STE 200 i !' <br /> AGOURA HILLS,CA 91301-4311 Billing Address:: 30101 AGOURA CT STE 200 <br /> AGOURA HILLS,CA 91301-4311 <br /> Phone: 1st: 209-465-4756 Phone: Hm: 800-624-5930 <br /> Wk: 209-465-4756 I. <br /> District 002-MARENCO,DARIO Location Code 01 -STOCKTON <br /> APN <br /> Date Abated <br /> Inspector <br /> .fes F"11 12 COPY <br /> Send Referral to: <br /> Referral Address: <br /> completed <br /> Referral Letter Sent by: <br /> Date: <br /> Complaint Status Code: <br /> 01 -Field Abated G�� 10-Substandard Property-See HOUSING ABATEMENT File <br /> 02-Office Abated 15-Active Housing Case-New Complaint See Active Case# <br /> 03-NAI Sent 16-Letter Sent To Tenant <br /> 04- Notice To Abate Issued 17- 15-Day Letter Sent <br /> 05- Enfomernent Action Initiated 50- Lead Hazard Evaluation Required(1) <br /> 06- EHD Permit Facility-See Linked Premise File 52- Lead Hazard Abatement in Progress(3) <br /> 07- Referred To Other Agency 53- Lead Hazard Visual Inspect Satisfactory (4) <br /> 08-Invalid/Unable To Verify 51 - Lead Hazard Work Plan Submitted(2) <br /> 09-Foodborne Illness 54-Lead Hazard Dust Evaluation Satisfactory(5) <br /> 11 -Multiple Complaints-See Active Case# 55- Lead Hazard Monitoring Schedule (6) <br /> 12-Enforcement Case-Transferred To LIQUID WASTE Rie 56-Lead Hazard Abatement Complete (7) <br /> 13- Enforcement Case-Transferred To SOLID WASTE File 57-Lead Hazard Property Vacant WlSoil Contamination <br /> 14- Enforcement Case-Transferred To ER File 58-Lead Hazard Case-See Active File For This Site <br /> 0104.rpt �. <br />