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l Y <br /> A <br /> _-Al� 02�� Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00045935 Site Location: 2824 FARMINGTON RD STE D Account ID: AR0002084 <br /> Receivedby: EE0000012 MARTORELLA Received Date: 3/8/2018 Print Date: 3/8/2018 3:07:01PM <br /> Assigned To: EE0008999 HUYNH Assigned Date: 3/8/2018 <br /> ProgramliFlement Code:1600-FOOD PROGRAM <br /> Complainant: : <br /> <br /> <br /> Nature ofcomplaint: <br /> FIRE AT LOCATION.UNKNOWN IF SUPPRESSANT SYSTEM ACTIVATED, <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 /> I-Intemel/Email S-Sheriffs Office <br /> ------------------------------------------------- <br /> PROPERTY INFORMATION OWNER INFORMATION <br /> Facility:FA0002076-SAMS DONUT Owner: OW0001619-SENG,MENGLONG <br /> Site Location 2824 FARMINGTON RD D RPIDBA SAMS DONUT <br /> STOCKTON,CA 95205 RP Address <br /> <br /> <br /> <br /> <br /> <br /> District 001-VR.LAPUDUA,CARLOS Location Code 01-STOCKTON <br /> APN 17306036 <br /> Date Abated -3/IJ—/(C6 InspectorlD#: ttu" 1 <br /> —————————————————————————————— ---------------———— <br /> Send Referral to Referral Letter Sent by <br /> Referral Atldress ` Date: <br /> Complaint Status Code: 6 1 <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected 50-LEAD Assessment Performed-No Abatement Required <br /> 02-Office Response Only 52-LEAD Abatement Regired-See Program Record File <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 /> 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 83-Septic system repaired <br /> 29-Alleged FBI-Major Violations Identified <br /> ompaint Reviewed by: ` ate Updated by: ate:Ll <br /> r <br /> 5104.rpt <br />