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\ PHS/ '. <br /> ✓JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: 5 /23/ q1 BY: w REVIEWED BY: DATE ENTERED: /,,-/-M / 7 BY: <br /> SWEEPS/SITE COD /&ZZ_ I PROGRAM/ELEMENT :03,C60 I COMP # FX.YN 2I LOC CODE IJ/ DIST # L�2/ <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS 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 RWOCS CONTACT WOR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT GW CONT y 2 a/ql DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 �2D3 I 92 I Z03 Z #3 (Z033 � 1203G- #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME EV V Q n y� n ^^n Iy 'JJ� <br /> ADDRESS 312-8 w• �1 W// 1 i n I"1 " ' Ve <br /> CITY ' bcK STATE co ZIP Z(j <br /> CONTACT NAME 1�����1(���L/////llll...�i�CCCC����---- L (n a�6n �IS f I✓1'� PHONE <br /> PROPERTY OWNER r 7 T <br /> COMPANY NAME X <br /> EXon /) / /� S , PHONE R60_g9 Z-3�N� <br /> CONTACT NAME 1�1 �^nW V PHONE / / /89 <br /> ADDRESS /lO <br /> CITY IIJJ (I STATE T-reZIP <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 # 1 �f3 DATE �I2gl�� PROP 65 # DATE 5/2�j 01/ PRIORITY <br /> STREET # I �JJI^�� SITE STREET Qpm O' } APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNr%,.o <br />