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PHS 4JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI� <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / �'Y / �/ BY: REVIEWED BY: DATE ENTERED: / BY: <br /> WEEPS/SITE CODE /(11/1- PROGRAM/ELEMENT 2 L U( COMP # 1,1/9- LOC CODE 0 T 1 <br /> DIST -2 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O O FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT e. ayl olZ_ DHS CONTACT N� -- <br /> OTHER CONTACT /W RWOCS CONTACT A/1/ WDR issued Y / NPDES issued Y /(� <br /> FAILED PT — SOIL CONT GW CONT _ OW CONT - ETROLEUM & <br /> SUBSTANCE #1 U 35/ #2 #3 94 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE y�a/9 ENFORCEMENT ACTION <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: / / c.ii7/Cavwr- <br /> SITE NAME 4J(.7u TU n A <br /> ADDRESS YJ /S 9S-/ U 6".SC ve,�Al, sly <br /> CITY y� STATE /� n 2IP <br /> ONTACT NAME /J VLt. T� ��7 PHONE <br /> PROPERTY OWNER G� <br /> COMPANY NAME r` ��/e /"� U` f' J_ PHONE <br /> CONTACT NAME C2 PHONE <br /> ADDRESS <br /> CITY S'!v--n <br /> rhGrH KCG— STATE C/i n„ ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME i-4 PHONE — - <br /> CONTACT NAME _.. PHONE <br /> ADDRESS <br /> CITY STATE ._. ZIP <br /> CONSULTANT �//.J _- - PHONE <br /> UAR # - DATE PROP 65 # /� DATE y _a-,F,/ PRIORITY <br /> STREET # �Sys� SITE STREET SPve�-A4 APN 11 /9S 1/0 <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) *R2 • <br />