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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH OIVIS`IUN <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / I / BY: REVIEWED DATE ENTERED: / / BY: <br /> SWEEPS/SITE CODE C/ PROGRAM/ELEM T OMP # LOC CODE DIST # <br /> UGT FILE PILOT FILE J H W FILE SITE MITIGATION PUS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT JJ WDR issued Y / N NPDES issued Y / N <br /> FAILED PT 3 SOIL CONT �^ Z� LI GW CONT Y 'l / DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 1,0 #3 Y� 94 #5 <br /> I 2 <br /> PRIOR FAILED PT 1. NO ACTJION CLEAN UP COMVPLIETE DA1E ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME (� r lam+ <br /> /! t 0 I <br /> ADDRESS h (�W <br /> CITY CAO <br /> ✓ ( STATE p{2 ZIP <br /> CONTACT NAME Saw�es �,�i--r S.� � (/f f PHONE I -7 <br /> PROPERTY <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 PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # +— b DATE I_ �()� `r! PROP 65 # �b._(��'3„ DATE �lzs q� PRIORITY <br /> STREET # 1. ISITE STREET APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />