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PIIS/SAN *NIOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE! / / BY: REVIEWED BY: DATE ENTERED: / / BY: <br /> zal <br /> SWEEPS/SITE CODE Cp 155-t PROGRAM/ELEMENT COMP # LOC CODE &Z- DIST # 3za <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT EH CONTACT DNS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPDES issuc6 ' ! N <br /> FAILED PT S014 CONT -7svIti&� I <br /> GW CONT DW CCHi I I, <br /> ETROLEUM N <br /> SUBSTANCE #1 92 I/A-�b y 93 1 #5 <br /> PRIOR FAILED PTNO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME JIvNGfjEST li=QIJU <br /> ADDRESS <br /> CITY L' 1.U� STATE �_ ZIP 91f"f�y� <br /> CONTACT NAME ,] 1 PHONE Z�►� 3 33- ion <br /> 64 <br /> PROPERTY OWNER <br /> COMPANY IIAME �'_I �' A D F Tyre PHONE ff f)1 2233- l7J?�j <br /> CONTACT NAME V'7/VY PHONE (�'vq� <br /> �i/�J �L�•9 �1L{1 L' <br /> ADDRESS <br /> CITY Gbh STATE c, ZIP �Lf Itf� <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # DATE �/Z 9 6 PRIORITY <br /> STREET # Zy(' SITE STREET �(� jfT�,�7/0 V - ` APN # <br /> 070 (7/89)- 89-19(IV) CNTMFR2 REVISED 12/94 <br />