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PHS/SmeQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISI0 <br /> CONTAMINATED SITES D-Base MFR - INPUT FORM / <br /> UPDATE: //� / O(l BY: REVIEWED BY: DATE ENTERED: �// ' / BY: 74.11 <br /> SWEEPS/SITE CODE -7 PROGRAM/ELEMENT COMP # LOC CODE DIST # <br /> LOT FILE PILOT FILEH 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 DNS CONTACT - - <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N 9POE5 issued Y / N <br /> FAILED PT SOIL CONT GW CONT DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 #2 #3 #4 #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 ! Zg — �T \ yy6I <br /> ADDRESS - <br /> CITY V�A..c� ^ `J STATE ZIP �i �� ca <br /> CONTACT NAME PHONE <br /> CERTY OWNER p <br /> COMPANY NAME y,� _I �.� i , 1 [�-4-('� PHONE <br /> CONTACT NAME (/ r PHONE <br /> ADDRESS 1 -(fit - u)o oc <br /> CITY <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME -Fe <br /> Al/1 to I 1��- PHONE <br /> CONTACT NAME �(�(/l (/ `.'l PHONE <br /> ADDRESS (�,. 13 <br /> CITY ��� .��� ���.� STATE o <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # DA7E PRIORITY ''��//�� <br /> STREET # �cl SITE STREET ) APN # /y0�-O 30 - <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 V <br />