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PHS/%�JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISi..� <br /> CONTAMINATED SITE D-Base PUT FORM <br /> UPDATE: / U ENTERED: / / BY: <br /> SWEEPS/SITE CODE t? PROGRAM/ELEMENTV,. 6- COMP # LOC CODE G DIST <br /> UGT FILE PILOT FILE W FILE SITE MITI PUS FILE PRIV WELL FILE -e NV ASS-c 55 <br /> SOLID WASTE H2O 0 FILE EPI FILE LANO USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWCS CONTACT WOR issued Y / N NPOES issued Y / N <br /> FAILED PT /—1 SOIL CONT / GW CONT OW CONT ETROLEUM Y / N <br /> SUBSTANCE #t i /J 3 (J #2 /F7� 2 #3 -4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE OAtE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME /l i Pro <br /> "�� <br /> ADDRESS /,3 / 5 "2 5 AAA— <br /> CITY V �� STATE . ZIP <br /> CONTACT NAME r/Yy' I L �( / PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME , G HONE <br /> CONTACT NAME ��I"'✓✓✓ inn ��1"`��� PHONE <br /> ADDRESS <br /> CITY STATE Z(P <br /> RESPONSIBLE PARTY (If different frau Property Owner) vv I <br /> COMPANY NAMEN Y r PHONE <br /> r V� J Y <br /> CONTACT NAME L� U ) PHONE _ y'3(.1-2// <br /> ADDRESS G^l O ) s�7,^ ' � (/ <br /> CITYJ , y STATE Z[P L� ��j <br /> CONSULTANT J PHONE <br /> UAR # wN o// DATE — PROP 65 # 4 y/// DATE � � PRIORITY <br /> STREET # L 2/ SITE STREET /�,J O �!/� [ J AP/N # 2j 10—JS <br /> EH 23 070 (7/B9)REVISED 03/91 89-19(IV) CHTMFR2 <br />