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Complaint Investigation Form Report#: 5104 <br /> COMPLAINT ID: C00039164 Site Location: 23078 GREEN LEAF RD Account ID: <br /> Receivedby: EE0002670 NAIDU Received Date: 1/30/2015 Print Date: 1/30/2015 11:05:54AM <br /> Assigned To EE0004045 TASIOPOULOS Assigned Date: 1/30/2015 <br /> Program/Element Code.4300-WELL PROGRAM <br /> Complainant: <br /> <br /> <br /> Nature of complaint: <br /> WELL HAS GONE DRY. NOT PUMPING WATER. <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 /> [-Internet/Email S-Sheriffs Office <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner:KENNETH&MARGARET ROOS TR <br /> Site Location 23078 GREEN LEAF RP/DBA : <br /> ESCALON,CA 95320 RP Address 1775 RUTH DR q <br /> Cross Street RIPON,CA 95366 9 /_ 70 <br /> Billing Address 1775 RUTH DR <br /> Home Phone :209-599-3037 <br /> Phone Work Phone <br /> District 004-VOGEL,KEN Location Code 99-UNINCORPORATED AREA <br /> APN 24729002 <br /> Date Abated e;_, Inspector ID#: <br /> - -- - - -�- -------- - - --- -- -- -------------- <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01 -FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> V OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 07-REFERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11 -Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104 rpt <br />