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JOAQUIN COUNTY - ENVIRONMENTAL HEALTH <br /> CONTAMINATED SITE D-Base MFR INPUT FORM pR <br /> UPDATE:3 / �� /qII BY.—7f? REVIEWED BY: DATE ENTERED: 'ryAR18 '99L" BY: <br /> SWEEPS/SITE CODE �DI ''Q((3 - /'P(R"FILE <br /> �3'2 CON, <br /> # LOC CODE DIST <br /> UGT FILE PILOT FILE HSITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE 1120 O FILE / ^ LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT fit '� SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y /� NPDES issued Y / <br /> FAILED PT SOIL CONT (Q I t `0 GW CONT DW CONT ETROLEUM U / N <br /> SUBSTANCE #1 l� 3 �0 #2 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN lJP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME ukL <br /> ADDRESS C) Fi <br /> CITY STATE C. } ZIP IS3- <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME vj Av PHONE <br /> CONTACT NAME // PHONE <br /> ADDRESS <br /> CITY 1111 -r STATE �- ZIP ;;I� <br /> CONSULTANT PHONE J <br /> UAR # DATE PROP 65 # // ` DATE �� O� PRIORITY <br /> STREET # D OD SITE STREET L'I��� APN # <br /> II <br /> EN 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 V <br />