Laserfiche WebLink
PHS/S_Am JOAGUIN COUNTY - ENVIRONMENTAL HEALTH OIVIFS <br /> CONTAMINATED SITE 0-9ase MFR - INPUT FORM <br /> IIPOATE:� / I� //`j BY: REVIEWED SY: " �f <br /> r C� vvv DATE" eH7ERE0: 7 / <br /> ,; <br /> SUE_PS/SITE E I�l I PROGRAM/ELEMENT 23 � CCNp $ GrJ�1VS d,/ LOC CODE Q' DIS/0 3 <br /> UGT FELE PILOT FILE/ H W FILE SITE MITIGATIONo- <br /> PUS FILE PRIV WELL FILE ENV ASSESS <br /> I1 <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER iAGENCY REPORT <br /> EMERGENCY RESPONSE <br /> I <br /> I( <br /> LEAD AGNCY/UNIT SJ/EH CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT RUOCS CONTACT <br /> WDR issued Y / N NPOES Issued Y / N <br /> FAILED P7I�JCJ SOIL CONT 3 <br /> I D �� I I Z�� C�� CONT 'IDW CONT ETROLEUN T / N <br /> SUBSTANCE 91 /Z O3 7?1- 03 <br /> i� "4 xS <br /> PRIOR FAILED PT HO AC7IOHill CLEAN UP COMPLETE DATE I <br /> a ENFORCEMENT ACTEOH Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 3 b DATE ACTION TAfEH: <br /> H <br /> SITE NAME <br /> ADDRESS <br /> CITY STATEF ZIP <br /> CONTACT NAME / <br /> PHONE <br /> PROPEZTY OWNER <br /> MNMEJ� <br /> PHONE `�3I PHONE <br /> STATE <br /> UsPONSIeLE PARTY (If different from Pr p <br /> Property OkrKr) � <br /> COMPANY NAME <br /> PHONE <br /> CONTACT NAME 31� <br /> PHONE <br /> I <br /> ADDRESS I <br /> . a i <br /> CITY <br /> . STATE ��� ZIP <br /> Il <br /> F ANT <br /> '1 PHONE <br /> UAR " DATE 2f /g <br /> PROP 65 x 4-C�5 f DATE 3 lg �� PRroRIrY <br /> STREET a SITE STREET <br /> APN ;9 <br /> EH 23 070 c7/89)REJIS8D 03/97 89-19(IV) C.YTMFR2 <br />