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PXS/F 'OAWIN COUNTY - ENVIRONMENTAL HEALTH DIVIS7 <br /> `etNTAMINATED SITE D-Base MFR - INPUT FORM ✓'I <br /> UPDATE:3 / n / AZ BY: C-# REVIEWED BY: DATE ENTERED: r� / �-L./ �j BY:oil <br /> / <br /> SWEEPS/SITE CODE PROGRAM/ELEMENT 2380 <br /> ,380 COMP # PAVFI X / LOC CODE D DIST 1.327 <br /> UGT FILE PILOT FILE X 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 /> r <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT - - <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPDESissued <br /> FAILED PT SOIL CONT / ,� GW CONT OW CONT ETROLEUM (9/ N <br /> SUBSTANCE #1 /np3�/ #2 / #3 1 1 #4 j 7#5 <br /> PRIOR FAILED PT 'C NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION I Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME way fC Al <br /> i oe <br /> ADDRESS <br /> CITY OCk�G� STATE ZIP CJjr2,0.� <br /> CONTACT NAME -70—Ajcg -Sc 7 <br /> v es " I PHONE .209- y62- a6 <br /> PROPERTY OWNER L <br /> COMPANY NAME q�J 2il�. (,{ k; PHONE 12o? _ 9Y3-54vo <br /> CONTACT NAMEf R/-C,,# PHONE ZO/�_p�3 <br /> ADDRESS 5000 E av s 7 ,7 <br /> CITY r L p.-i STATE �.n ZIP <br /> RESPONSIBLE PARTY (If different frau Property Owner) PAA4I'I4 <br /> y'! <br /> S <br /> COMPANY NAMEPHONE <br /> e � T c l<i <br /> CONTACT NAME eI- �rr1 PHONE <br /> ADDRESS <br /> CITY <�N STATE �,�p ZIP S <br /> CONSULTANT '1 PHONE <br /> UAR # DATE 3J17'/oZ PROP 65 # DATE 371-?19Z PRIORITY <br /> STREET # z i s o SITE STREET F/-•�,y�ON S'/- / APN # <br /> EH 23 070 (7/89)REVISEO 03/91 89-19(IV) CNTMFR2 <br />