Laserfiche WebLink
PHS/'79 JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIo7-+, <br /> CONTAMINATED SITE D-Base MFR INPUT FORM <br /> UPDATE: / 2 /q ZBY: Pv REVIEWED BY: (y,J DATE ENTERED:��(( Z/ BY: <br /> Fuc <br /> EEPS ITE C Z I`j PROGRAM/ELEMENT P _/ LOC CODE (b/ DIST <br /> T FILE PILOT FILE H W FILE SITE MITIGATIONIV I PWS FILE 1 PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT T <br /> EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT C�I SJ/EH CONTACT DHS CONTACT - - <br /> OTHER CONTACT RWOCS CONTACT WDR issued Y / N NPOES issued Y / N <br /> FAILED PT SOIL CONT ��/, Z GW CONT OW CONT ETROLEUM Y / N <br /> SUBSTANCE #116 1 #2 #3 #4 1 #5 <br /> PRIOR FAILED PT V NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> EN�FOORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME U <br /> ADDRESS ( �D <br /> CITY �I/ rt-Ky� STATE �,c(- 2IP �SZ6 <br /> CONTACT NAME l5•� I V i V , PHONE <br /> PROPERTY OWNER 1 / <br /> COMPANY NAME U I /J l� PHONE <br /> Ci li <br /> CONTACT NAME W r ` �,(� PHONE <br /> ADDRESS <br /> CITY ��1� STATE ZIP <br /> RESPONSIBLE PARTY (If dif event from Property Owner) <br /> COMPANY NAME '••� PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS ` <br /> CITY \ STATE ZIP <br /> CONSULTANT w IX I/ V1 v 1 f/� N` PHONE <br /> UAR C(cv I 1 (DATE �1 ' 'fjl Cj PROP 65 # ��_Lf�a ATE � 7/ �Z- PRIORITY I (/ <br /> STREET # l SITE STREET( �/� Gt.� � r) AFM <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 VVV <br />