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t, <br /> Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: C00053161 Site Location: 25 FRENCH CAMP RD Account ID: <br /> Received by: EE0009825 AFONSKAIA Received Date: 12/17/2020 Print Date: 12/17/2020 4:08:34PM <br /> Assigned To: EE0009825 AFONSKAIA Assigned Date: 12/17/2020 <br /> Program/Element Code 4300-WELL PROGRAM <br /> Complainant: ANONYMOUS <br /> Home Phone <br /> E-Mail Address <br /> Nature of complaint: <br /> WORK CONDUCTED ON OUT-OF-SERVICE WELL WITHOUT PERMIT. <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-Internet/Email S-Sheriffs Office <br /> ------------------------------------------------ - <br /> PROPERTY INFORMATION RESPONSIBLE PARTY INFORMATION , /! <br /> Property Name: RPDBA �r , /,. ~ -rK,I"—J�p* ! <br /> Site Location 25 FRENCH CAMP RD RP mailing address n^Oc�c <br /> FRENCH CAMP,CA 95206 <br /> Cros Street ELDORADO <br /> Mailing address RP contact <br /> RP contact phone <br /> Phone <br /> Property Owner:BARBARA MEYER <br /> DBA <br /> Owner address <br /> Billing Address 1151 HARVARD RD <br /> PIEDMONT,CA 94610 <br /> <br /> <br /> <br /> <br /> <br /> ��L ———Inspector ID#� ids <br /> Send Referral to 1 Referral Letter Sent by <br /> Referral Address Date: <br /> Complaint Status Code: (� , <br /> Circle appropriate Status Code <br /> 01-Field Response-Violations Cited and Corrected n 29-Alleged FBI-Major Violations Identified <br /> 02- ffice Response Only ►�/p O p4 , q�'Of. 50-LEAD Assessment Performed-No Abatement Required <br /> Violations Cited-see Linked PROGRAM FACILITY FILE 52-LEAD Abatement Reqired-See Program Record File <br /> 07-Referred to Other Agency 97-Disaster Planning and Response <br /> 08-Unable to Verify Alleged Complaint 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File MN-EHD Monitoring Status <br /> 11-Multiple Complaints-SEE ACTIVE CASE# PD-Permit Issued-Pending Well Installation <br /> 12-DA Referred Complaint-See Program Enforcement Action Form RS-Resolved-New Well Installed <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# S1-Tank pumped <br /> 28-Alleged FBI-No Major Violations Identified S2-Hooked up to public sewer <br /> omp aint Reviewed by: i Date: p ate y: ate: I <br /> 5104.rpt <br />