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W'ITJSAN JOAQUIN CCUNTY - ENVIRONMENTAL HEALTH DI`T'ON <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: /Z-7 /Gt BY: REVIEWED BY: DATE ENTERED: !�1 / J / By' <br /> SWEEPS/SITE CODE r PROGRAM/ELEMENT �7 `Ij � COMP # /G LLOC CODE # 50,:P <br /> LOT FILE PILOT FILE H W FILE SiTE MITIGATION PWS FILE PRIV WELL FILE / ENV ASSESS <br /> SOLID WASTE 820 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCYNNIT SJ/EH CONTACT � S CONTACT - - <br /> OTHER CONTACT RWOCB CONTACT WDR issued Y / N NPDES issued Y / N <br /> FAILED PTMPTNOOACTIOON <br /> IL CONT 511'7 GW CONT DW CONT ETROLEUM C / N <br /> SUBSTANCE #2 Z0?j1' #3 #. #5 <br /> PRIOR FAILCLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / <br /> E <br /> 3/3 <br /> ENFFOO <br /> RCEMENT TYPE: 1 2 3 L 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS /,352 /' <br /> CITY 7 '^`DV cJCJ STATE A ZIP Gf� <br /> CONTACT NAME PHONE y�5e J(YZ-pZZ <br /> PROPERTY OWNER <br /> COMPANY NAMEG, ' /� � PHONE / <br /> CONTACT NAME �s1 T PHONE ���)�zZ— 900-- <br /> ADDRESS <br /> CITY /�1 . ! � . STATE G ZIP Cj� <br /> RESPONSIBLE PARTY (If different from Property Owner) �J <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # G,'/ DATE PROP 65 # l p�D(o DATE L) PRIORI <br /> STREET # l �?�?�- SITE STREET NCL�y �� APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />