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PIIS;"P. JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISi <br /> ] I , CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / q%BY: hof/ REVIEWED BY: -t_ DATE ENTERED: / ,� I / BY: <br /> SWEEPS/SITE CODE /Q_�/� PRVO'�GRAM/ELEMENT COMP # LOC CODE DIST # <br /> UGT FILE lap <br /> ILOT FILE "6PIFILE <br /> SITE 111TIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE 1120 0 FILE LAND USE FILE 0 <br /> Ti1ER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT S_ >D _ SJ/EH CONTACT ISS DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / ! HPDES issued Y /(2f) <br /> FAILED PT 1 -Y� SOIL CCNT Ct_,`-t-93 GW CONT OW CONT ETROLEUM N <br /> SUBSTANCE #1 IO 6 Z� l #3 O©3/ 94 #S <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y <br /> EIIFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS S--C) A 11GS ISG ✓� D �� ���� <br /> CITY �n STATE ZIP <br /> CONTACT NAME QN PHONE Zip <br /> PROPERTY OWNER l9 T <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME pl{ONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT y' PHONE <br /> UAR # J DATE PROP 65 # / '' DA7E PRIORITY <br /> STREET # ^ C J O I SITE STREET S �C. APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />