CEPD Case Referral Form

WE ARE NAPA COUNTY

Consumer Environmental DivisionOffice of the District Attorney

 

Date of Referral    [None] Select a Date Delete the Date   Referring Agency  
Referring Employee     Contact Info.  
Napa DA Case No.     Previous Injunction/Probation  
  
 VIOLATOR(S) - Individual and/or Business Entity
Individuals: Include Full name, DOB, Address, phone numbers, physical description, CDL Number.   
Business/Corporation: Type of entity; address; Manager/Supervisor; contact information; FBN; Corp. license No.

 

 1.   2.  
3.    4.  


VIOLATION(S)

Offense Date  [None] Select a Date Delete the Date

Identify specific State Law, Administrative Regulation, County Code/Ordnance or Permit/License conditions allegedly violated. Please separate each violation numerically. (Ex: 1,2,3...etc.) 

 

Please send the supporting documents (ADC form and other agency violation documents) to CEPD@countyofnapa.org

Complete copy of agency file   (Include Reports, All Correspondence, notes, etc
Photos, maps, charts
Test results
Expert witness information (include cv, scientific or technical articles)
Previous warnings, abatement orders, citations, notice of violation (attach copy of certified return receipt)
Copies of all documents, correspondence provided by violator and/or their representative
Copies of all licenses and permits
Assessor Parcel Number, Tax Assessor Records, Zoning Map, Property Ownership History
Copies of local ordinances, regulations or specific orders
Physical evidence, property reports, chain of custody
Investigation Costs (Include as a separate attachment)

BRIEF DESCRIPTION OF THE CASE 
   

 

Inspector Name Date  [None] Select a Date Delete the Date