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SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH 0*ON <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: BY: CCTT REVIEWED BY: DATE ENTERED: /O/ / / ! BY: <br /> SWEEPS/SITE CODE /c'l 79 PROGRAM/ELEMENTCOMP # <br /> Z3 � 'o LOC CODE DIST # <br /> UGT FILE PILOT FILE H V FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE N20 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNITSJ/EH CONTACT <br /> � CES C-�,- DHS CONTACT - - <br /> OTHER CONTACT RWOCB CONTACT WDR issued11 <br /> Y <br /> / N NPDES Issued Y / N <br /> FAILED PT .� SOIL CONT (�45�/&/ GW CONT <br /> / DW CONT ETROLEUM �yJ'/ N <br /> SUBSTANCE #1 <br /> /r9ti v33 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE <br /> ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> MNAME <br /> STATE ZIP. o ai PHONE gyp% <br /> PROPERTY OWNER <br /> COMPANY NAME <br /> PHONE <br /> 3/r0 <br /> CONTACT NAME <br /> re'— PHONE <br /> ADDRESS <br /> CITY <br /> STATE ZIP G <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME <br /> PHONE <br /> CONTACT NAME <br /> PHONE <br /> ADDRESS <br /> CITY <br /> STATE Z(p <br /> CONSULTANT <br /> PHONE <br /> UAR # DATE �5 ��t/ PROP 65 k DATE <br /> ����// PRIORITY <br /> STREET # SITE STREET S-� c0� <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 J <br /> i <br />