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PHS/ JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIUN <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM / <br /> .11 dq <br /> UPDATE n 4z- BY / REVIEWED BY DATE ENTERED L/ a//Cl/� BY <br /> ADDITION• 177 EDIT: 666 <br /> SWEEPS # SITE CODE u 2 / COMP # LOC CODE O DIST # Z <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O Q FILE EP! FILE LAND USE FILE OTHER AGENCY REPORT H W SPILL/DISPOSAL <br /> PROGRAM/ELEMENT LEAD AGENCY/UNIT SJ/EH CONTACT <br /> RWQCB CONTACT C/ DHS CONTACT OTHER CONTACT <br /> FAILED PT SOIL CONT GW CONT DW CONT PETROLEUM Y / N <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME PHONE <br /> ADDRESS /rye <br /> CITY STATE ZIP <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <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 PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> _7 <br /> UAR # DATE PROP 65 #7 <br /> DATE PRIORITY <br /> STREET # 0� / SITE STREET APN # <br /> EH 23 070 (7/89)REVISED 11/90 89-19(IV) CNTMFR2 <br />