Laserfiche WebLink
PHS/SANOXIN COUNTY - ENVIRONMENTAL HEALTH DIVISION• <br />CONTAMINATED SITE D-3ase MFR - INPUT FORM <br />�� SY: REVIEWED BY: � -� /c2 / / /y BY: 9.DUPDATE:j <br />SWEEPS/SITE CODE <br />PROGRAM/ELEMENT <br />Z <br />COMP d <br />7 <br />0C CODE <br />STATE �Gj <br />DIST S <br />CONTACT NAME <br />LOT FILE <br />PHONE <br />PILOT FILE <br />Y /0 <br />H W FILE <br />Y / <br />SITE MITIGATION <br />ZIP <br />PWS FILE <br />PRIV WELL FILE <br />DEE: <br />SOLID WASTE <br />H2O 0 FILE <br />EPI FILE <br />LAND USE FILE <br />OTHER AGENCY REPORT <br />EMERGENCY RESPONSE <br />LEAD AGNCY/UNIT <br />—�U`A <br />SJ/EH CONTACT <br />l�.` ,iL 3 0 1 <br />DNS CONTACT <br />- - <br />STATE �Gj <br />OTHER CONTACT <br />CONTACT NAME <br />RUOC3 CONTACT <br />PHONE <br />'WOR issued <br />Y /0 <br />NPDES issued <br />Y / <br />FAILEO PT SOIL CONT ?y GW CONT OW CONT PETROLEUM N <br />SUBSTANCE '.1 /Zo 3 L 92 `3 ;t 45 <br />PRICR FAILEO PT 40 ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br />ENFORCEMENT TYPE: 1 2 3 G 5 6 DATE ACTION TAKEN: _/_/_ <br />S[TE NAME <br />�—\ 0 c / V" \i yl1 ✓� ` U(( <br />ADDRESS <br />� 2v S I A C (C -CLQ <br />CITY <br />/'yam <br />/ <br />STATE �Gj <br />ZIP <br />CONTACT NAME <br />/1 <br />q. 1 _!/ems 1 I(_ <br />PHONE <br />/ y2CY <br />PROPERTY OWNER <br />COMPANY NAME <br />'I u n /f/f / �v <br />PHONE <br />C'?_� y <br />/ <br />CONTACT NAME <br />/'yam <br />/ <br />PHONE <br />?3 /y PRIORITY <br />ADDRESS <br />STREET <br />ADDRESS <br />4J <br />CITY <br />/� <br />STATE <br />�7j// <br />ZIP <br />y'S 36 � <br />RESPONSIBLE PARTY (If different from Property Owner) <br />COMPANY NAME <br />�•vHG <br />PHONE <br />C'?_� y <br />/ <br />CONTACT NAME <br />/'yam <br />/ <br />PHONE <br />?3 /y PRIORITY <br />ADDRESS <br />STREET <br />CITY <br />Zv1 <br />STATE <br />ZIP <br />�7j// <br />CONSULTANT - PHONE <br />UAR 4 <br />DATE <br />C'?_� y <br />/ <br />PROP 65 9 <br />/'yam <br />/ <br />DATE <br />?3 /y PRIORITY <br />STREET <br />0 <br />Zv1 <br />SI6ITE STREET- <br />5� <br />�7j// <br />APN 7 <br />EH 23 070 (7/89)REVISED 03/91 89. 19( EV) CNTHFR2 <br />Uoj <br />