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PN"SCAN J0AQUIN COUNTY - ENVIRONMENTAL HEALTH DIy1SION <br /> CONTAMINATED SITE D-Base MFR - JNPUT FORM <br /> UPDATE: 3 / / / 97 BY: 7 REVIEWED BY: ATE ENTERED: C3/ W/ y- BY: Sr! <br /> SWEEPS/SITE <br /> `COODE ,iCL1.?03 PROGRAM/ELEMENT �D COMP, q I LOC CODE Q I ( DIST % I <br /> LOT <br /> FILE R PILOT <br /> ((JJFILE `.J X W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> c / ` <br /> 3 <br /> SOLID WASTE H20 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE' <br /> LEAD AGNCY/UNI "" SJ/EH CONTACT HS CONTACT - - <br /> OTHER CONTACT y RWOCS CONTACT WDR issued Y <br /> / N NPDES issued Y / N <br /> FAILED PT SOIL CONT �_ „ LL GW CONT <br /> / DW CONT ETROLEUM Y / N <br /> SUBSTANCE %1 /a D3 !/ %2 D�'sE�3 1 %3 10 ✓d�f a 3 1 94 -S <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: u 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME [\7-4 G , <br /> ADORESS 7 z1Ct V ���✓�`��� <br /> CITY C D c- �7-� 7— STATE C Zip 9� O <br /> CONTACT NAME Iq (j /����.y PHONE ao q q,3 (G' L <br /> PRCPERTY OWNER V <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CRY STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT '/ PHONE <br /> UAR % CNVl/ DATE -.//.� �y� PROP /65X y//o3y DATE /3 -//—�y PRIORITY <br /> STREET % I SITE STREET / -S I / /� n / APN % <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 / ��/•••!!!/// <br />