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PHS/SAN OAOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION"" <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: /Z5 /Q4 BY: 1 REVIEWED BY: DATE ENTERED: / / BY: <br /> SWEEPS/SITE CODE PROGRAM/ELEMENT COMP # LOC CODE DIST # <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 /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPDES N <br /> FAILED PT SOIL CONT /fig lQ� GW COIIT DW CONT ETROLEUM (3 / N <br /> SUBSTANCE #1 L (:)LZ, stn t, #2 ! #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 A 5 6 DATE ACTION TAKEN: <br /> SITE NAME ;�-1 Z—rr 'r40yY-%c,s LLC <br /> ADDRESS <br /> CITY f�G STATE 21P <br /> cA <br /> CONTACT NAI4E },� G\\ \ V - PHONE 2�i� $39_E$9S <br /> PROPERTY OWNER 1 ' <br /> COMPANY NAME �f l 5-- -� loO yy1GS LLG PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS 0 (� <br /> CITY A1STATE 1' ZIP <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT / PrjHONE cz0g) Qj3�_2895 <br /> UAR # C��_U ZI DATE �p/20/Q PROP 65# DATE /zo Q� PRIORITY <br /> STREET a 132.5 SITE STR(((EET COf'(�.,� �Ql(Ou� APN # <br /> EH 23 070 (7/89) 89-19(IV) CNTMFR2 REVISED 12/94 <br />