Laserfiche WebLink
PHS/SAY "-AOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIO <br /> ,,K, TAMINATED SITE D-Base MFR - INPUT FORM `W/ <br /> UPDATE: 49 t <br /> gY; n REVIEWED BY: /,/)DATE ENTERED: BY: <br /> j b /�s ` <br /> SWEEPS/SITE CODE Z7 ROGRAM/ELEMENT COMP # LOC CODE DIST # 32-s'- <br /> UGT FILE LOT FILE H W FILE SITE MITIGATION PUS FILE PRIV WELL FILE NV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT —- <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPOES issued Y / N <br /> FAItD PT SOIL CONT !®/ p' GW CONT OW CONT �ETROLEUM Y / N <br /> SUBSTANCE #1 #2 / #3 #4 #5 <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 /> // <br /> SITE NAME - Corrlo z(x Gee N <br /> _ <br /> ADDRESS 2 _IA f <br /> CITY L ��l STATE /'/1 ZIP <br /> CONTACT NAME /_ PHONE _ —13``!S' <br /> PROPERTY OWNER �1 <br /> COMPANY NAME © �1 �� w l PHONE _ S- <br /> CONTACT NAME ©J� / t ry PHONE <br /> ADDRESS O �'oX to <br /> CITY ^) / STATE C 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 # DATE PRCP 65 :# E/ <br /> DATE / o�s / PRIORITY <br /> STREET # ^>� SITE STREET /� ,�„ / APN # Al _300 �03- $' <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 ` MSO/ <br />