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P119PTAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV"fbN <br /> CONTAMINATED SITE U-Base MFR - INPUT FORM <br /> UPDATE: 12 /2.y / 43 BY: REVIEWED BY: DATE ENTERED: JAN ® 7199-r BY: <br /> SWEEPS/SITE CODE Z� L�!' PROGRAM/ELEMENT COMP # OC CODE DISV# <br /> UGT FILE lip <br /> ILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSE 55 <br /> SOLID WASTE 1120 O 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 WOR issued Y / N NPDESissued Y / N <br /> FAILED PT SOIL CONT • GW CONT DW COAT ETROLEUM Y /0 <br /> SUBSTANCE #1 #2 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE I G, 'LL{ 1 3 ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME ccas I co 0el+14 �& nEly, ,✓`, -ss <br /> ADDRESS 4-1 -51 1 hc,L�5{-r i ���l..Q <br /> CITY `trar.ft ^f <br /> CONTACT NAME c�Oh� �,Q�7�-{�`GSL/✓ ` PHONE b� rj-[Xp L.� <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE <br /> CONTACT NAME -30 ,B eCD L) V--r PHONE <br /> ADDRESS gp -t— <br /> CITY <br /> CITY Lc D re, STATE / /,Q- ZIP � L13 0- <br /> RESPONSIBLE PARTY (If different from Property Owner) V <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATELl <br /> PROP 65 #I l DATE PRIORITY <br /> STREET # 413/ SITE STREET I I (�5tr1 �I APN # 2I 2_-2CO -:fEH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 I <br />