Laserfiche WebLink
PNS/SA1..,6ACUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIC` <br /> CONTAMINATED SITE 0-9ase MFR - INPUT FORM <br /> �/ n / REVIEWED ST: DATE ENTERED: n/ /�� /!� BY: <br /> UPDATE: I/i /2'f-1 q7-ay: T <br /> StiEEPS SITE CCOE <br /> 2 5°I I P0.0GRAM/ELEMENT COMP x CTo P Y LOC COOE O/ 01ST x <br /> � SITE MITIGATION PUS FRE PRIV WELL FILE ENV ASSESS <br /> UGT FILE PILOT FILE H W FILE <br /> H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> SOLID WASTE <br /> LEAO AGNCYNNIT <br /> (/ J/EH CONTACT DHS CONTACT " <br /> RWOCS CONTACT W9R issued Y / N NPDES issued Y / N <br /> OIHEA CONTACT �7 <br /> FAILED PT 1 9 8 9 �2'ZZ DW CONT ETROLEUM 0/ N <br /> SOIL CONT GW CONT <br /> '-Z x2 x3 is <br /> svesrz4c_` 91 <br /> PRICR FAILED PT NO ACTION CLEAN UP COMPLETE DATE EN FCRCEMENT ACi ION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKE4: <br /> SITE 4AME C I �,OSCtc-i-m� �l/ a✓(L <br /> ACDRE-aS ' 'r- ^b,n'.nl— . <br /> CITY I <'�/JX ',� STATE I 2IP <br /> CA '2/,Q5/2/�0//3 <br /> PHONE <br /> {INTACT NAME n <br /> PRCPE.RTY OWNER <br /> /,A PHONE <br /> 90,29; <br /> / 'T� PHONE �9/ p /;�)/�Z;J /V Q/C�r7 y�vl STATE 2IP / Cj <br /> RESPCNSIBLE PARTY (If different from`P'r� tCpe�r�ty Omer) <br /> PHONE <br /> CMPANY NAME <br /> PHONE <br /> C'_'NTACT NAME <br /> ADDRESS <br /> STATE ZIP <br /> CITY <br /> PHONE <br /> GNSULiANT <br /> n p / PRICRITY <br /> UAR t (j•1 �, DATE I / i22�-( PROP 65 2 -,SSD _ ATE Z-�j/i <br /> l v Dnn APN x <br /> STREET t (� SITE STREET <br /> Z.4 Z3 O70 (7/89)RONED 03/91 89-19(:V) C.HT.012 <br />