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PHS JOAOUIN COUNTY - ENVIRONMENTAL HEALTH OIVI' `i <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: BY: REVIEWED BY: �,/ DATE ENTERED: /) / `/ 8 <br /> SWEEPS/SITE CODE �K 6 PROGRAM/ELEMENT 3 3� COMP # /YIUfjic (ea LOC CODE V/ DIS # ja3 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O D FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEADAGNCY/UNIT SJ/EH CONTACT 26211 Thy« DHS CONTACT - - <br /> OTHER CONTACT RWOCS CONTACT I I <br /> WOR issued Y / N NPOES issued Y / N <br /> FAILED PT SOIL CONT d / GW CONT DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 (d 3 d� #2 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION li? / N <br /> ENFORCEMENT TYPE: 1 (/1 J 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS <br /> CITY STATE ZIP 1"S <br /> CONTACT NAME P`J�S SSC (�w {(� PHONE �U9 gYC/'S/v 7J <br /> PROPERTY OWNER <br /> COMPANY NAME IPL��s (^/ /(w PHONE <br /> CONTACT NAME G -c `J y'rc PHONE <br /> ADDRESS <br /> CITY / l�r7 STATE C19 ZIP 41 3.0 1 <br /> 1U L <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> Su <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT / PHONE <br /> UAR # I_ " �L DATE �/6�4 j PROP 65 # r , T-d DATE Ale,/-- PRIORITY <br /> STREET # / SITE STREET �� ��j-�h�C, APN # �j j -/(. -0'?- <br /> EH 23 070 (7/89)(REEVISED 03/91 89-19(IV) CNTMFR2 <br />