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i Complaint Investigation Form Report#.5104 <br /> COMPLAINT ID: 000032237 Site Loca : 9015 W WALNUT GROVE AccountlD: AR0026117 <br /> Received by: EE0005366 MEDINA Received Date: 6/24/2010 Print Date: 6/24/2010 4:39:38PM <br /> Assigned To: EED005366 MEDINA Assigned Date: 6/24/2010 <br /> EMENRlr5107ent Cor1a.' 200-LIQUID WASTE PROGRAM <br /> Complainant: :LISA MEDINA,EHD Home Phone <br /> Address Work Phone <br /> E-Mail Address <br /> Nature of corn Taint: <br /> UPON ROUTINE INSPECTION IT WAS OBSERVED BY EHD STAFF THAT EFFLUENT WAS SURFACING AT FILTER BED#3. <br /> Complaint Mode: OComplaint Made Codes A-Agency Referral B-Bd of Supervisors t City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail/Correspondence O-Other EH Unit P-Phone <br /> [-Internet I Email S-Shedfrs Office <br /> ------------------ ------------------------------ <br /> FACILITY INFORMATION OWNER INFORMATION <br /> Facility:FA0014767-THORNTON CHEVRON Owner: OW0011767-JD SINGH SERVICE STATIONS,INC <br /> Site Location 90I5 W WALNUT GROVE RP/DBA : <br /> THORNTON,CA 95686 RP Address 24I0 TECADO TERRACE <br /> Cross Street FREMONT,CA 94539 <br /> Mailing Address: 44301 HUNTER TERRACE Billing Address 2410 TECADO TERRACE <br /> FREMONT,CA 94539 FREMONT,CA 94539 <br /> Home Phone :209-794-8993 <br /> Phone :209-794-8993 Work Phone <br /> Distdct 004-VOGEf,,KEN Locatbn Code 99-UNINCORPORATED AREA <br /> APN 00114040 <br /> Data Abated -�Si 7 '_— Inspe for <br /> ——————————————— <br /> Send Referral to Referral Letter Sent by <br /> ReferraiAddress Date: <br /> Complaint Status Code: 0,,-' <br /> Circle appropriate Status Code <br /> Q51FIELD ABATED 50-LEAD Assessment Performed-No Abatement Required <br /> 02-OFFICE ABATED 52-LEAD Abatement Regfred-See Program Record File <br /> 03-NAI SENT 97-Disaster Planning and Response <br /> 04-NOTICE TO ABATE ISSUED 99-UNSPECIFIED-Old Complaint-No Original Found-Pre-tracking <br /> 06-EHD FACILITY-see Linked PROGRAM FACILITY FILE CL-Case Closed <br /> 07-REFERRED TO OTHER AGENCY <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 /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 28-FOODBORNE ILLNESS-No Major Violations identified <br /> 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 51GCgX <br />