Laserfiche WebLink
PHS/Sl AOUIN COUNTY - ENVIRONMENTAL HEALTH DEVISE <br /> Z <br /> NTAMINATED SITE O-Base MF - INPUT FORM <br /> UPDATE: 'Z / r(7 / 933Y: REVIEWED BY: ,P,SZ ;7 DATE ENTERED: / _ / BY: <br /> SWEEPS/SITE CODE // 7J� PROGRAM/E[EMENT )!:�o'� COMP # LOC CODE DIST # <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 RESPONS'c <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT - - <br /> nD6�II / <br /> OTHER CONTACT RWOCS CONTACT WOR issued Y /� NPD ES issued /�/ N <br /> FAILED PT hhhh"''fffTn�AA���� SOIL CONT GW CONT =ETROLEUMSUBSTANCE #1 z7L #2 #3 #4PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME C�� [,�q <br /> ADDRESS •X G All (� <br /> 1 CITY STATE ZIP ( <br /> CONTACT NAME IeAD�Cf y) PHONE -�rK7 a sd -257,1 <br /> PRCPERTY OWNER <br /> PHONE <br /> COMPANY NAME <br /> CONTACT NAME Vk c),./!:$f PHONE y�5� g6 y-333 <br /> ADDRESS J©V Vt x 3 C <br /> CITY �CGLnCi �GCJ J sTATE �q zip 5 NP1#— 37/,5 <br /> r` <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> PHONE <br /> CONSULTANT <br /> UAR # -, { DATE ESTREET <br /> PROP 65 # �� '3� PRIORITY <br /> STREET # ( G L.a� APN # <br /> 23 070 (7/89)REVISED 03/91 89-19(IV) C4TMFR2 <br />