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/SAN JOAGUIN COUNTY - ENVIRONMENTAL HEALTH &".AON <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: (?Z-BY: �/ REVIEWED BY: DATE ENTERED: 'j / / /`�7i' BY: <br /> " <br /> 2 / ZQ/ / r <br /> SWEEPS/SITE COO /1557 OGRAM/ELEMENT CCMP # Kl/V j�71 // LOC CODE g9 D RT x <br /> UGT FILE ILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT ENERG'cNCY RESPONSE <br /> LEAD AGNCY/UNIT 0 SJ/EH CONTACT DHS CONTACT ' - <br /> OTHER CONTACT RWCCS CONTACT WOR issued Y / N NPOES issued Y / N <br /> fA I!ED PT SOIL CONT /i vv GW CONT ✓ IO C/ / DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 I Z O:�>-Z- <br /> 02 0 44 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME .� ((� <br /> ADDRESS / D n �� vL� / "'�"� 20` <br /> CITY n t/ Y-M STATE ZIP <br /> CONTACT NAME N n'' vv,, l� PHONE �95/-Z18� <br /> PROPERTY OWNER /LX.. <br /> COMPANY NAME W(f SQ� , /�-!� PHONE zoq -q5l oll 88 <br /> CONTACT NAME1 /T�l/Y vVl !1-I�/ PHONEVVI <br /> ADDRESS 16 3 0 n L� ( tJ <br /> / - <br /> CITY STATE A ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) v v <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> L <br /> UAR DATE (N R Z PROP 65 # n DATE 2 /N -L PRIORITY <br /> STREET # / J D SITE STREET �( h-1- ( /� APN # <br /> EH 23 070 (7/89)REVIS"eD 03/91 89.19(IV) CNTMFR2 <br />