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PNS JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV! i <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM *40.4 <br /> UPDATE: /2�/9) BY: REVIEWED BY: DATE ENTERED: 7 /Zy BY: <br /> SWEEPS/SITE CODE Z_/SJR PROGRAM/ELEMENT Z3 ,�li COMP # G7�5 9J LOC CODE T DIST # Z <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O O FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT /1 SJ/EH CONTACT DHS CONTACT - - <br /> OTHER CONTACT C� RWOCB CONTACT WOR issued Y / N NPDES issued Y / N <br /> FAILED PT 3/7—Q SOIL CONT /'�h/ GW CONT /76h DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 JZO3 1 lZD3Z #3 ((( #4 #5 <br /> PRIOR FAILED PT NO ACTIONCLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME e-I-e/S '?� Ila(11e' <br /> ADDRESS W .1/. 1 .?lave <br /> [J <br /> CITY 54on✓v YYY nnn11f / I STATE c/9- ZIP -6Z� <br /> CONTACT NAME n j `�[T n� fi�/�'� � Y� PHONE 909 q6Z -Zg�� <br /> PROPERTY OWNER vv�V �' LX w !� <br /> COMPANY NAME PHONE <br /> CONTACT NAME �V PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME /,I PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT / PHONE <br /> UAR # rqI- bbA <br /> DATE /,7 9/ PROP <br /> /65 # 0 �lO DATE ys9/ PRIORITY <br /> STREET # SITE STREET APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 / ' <br />