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PHSYSl� JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV " <br /> \ iCONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / BY: REVIEWED BY: DATE ENTERED: y /yy / �J� BY: <br /> SWEEPS/SITE CODEPROGRAM/ELEMENT COMP # LUiJG L a I LOC CODE p f DI T # 32-3 <br /> a S S-cl 3 3 $'1D <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PR1V WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSe <br /> LEAD ACNCY/UNIT SVEN CONTACT DHS CONTACT -- <br /> OTHER CONTACT RWOCS CONTACT WOR issued Y / IN NPOES issued Y / <br /> FAILED PT SOIL CONT 3_3 _ 4 GW CONT OW CONT ETROLEUM Q/ N <br /> SUBSTANCE #1 �/� <br /> 02 93 94 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 /1 DATE ACTION TAKEN: <br /> SITE NAME LU wP S4 �eS <br /> ADDRESS F - CAl a r <br /> CITYS�G/c- n STATE C = ZIP cf S oU-US <br /> CONTACT NAME /J PHONE <br /> d, tccar <br /> PROPERTY OWNER <br /> COMPANY NAME i q e a G GQ� D PHONE <br /> CONTACT NAME PHONE <br /> vv<P <br /> ADDRESS r�$S,y /if <br /> CITY r 'vn STATE C-4 ZIP Yf SoIU <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 PR 65 GATE 3 -31_9 R(ORITY <br /> STREET it SITE STREET G LH✓7Pl� APN <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />