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I <br /> PHS/S,... JOAOUIN COUNTY - ENVIRONMENTAL HEALTH OIVIS,-.. <br /> CONTAMINATED SITE D-Base MFR INPUT FORM <br /> UPDATE: 7 BY: REVIEWED BY: DATE ENTERED: <br /> SWEEPS/SITE CODE PROGRAM/ELEMENT COMP # [LOC CODE 61 DIST # <br /> UGT FILE V PILOT FILE H W FILE SITE MITIGATION PWS FILE PR1V WELL FILE ENV ASSESS <br /> SOLID WASTE H2O Q FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT _ �-� SJ/EH CONTACT a L¢� DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT GW CONT r�3 e OW CONT ETROLEUM / N <br /> SUBSTANCE #1 6 3 Y,o � 1 #2 7 / v 93 #4 #5 <br /> PRIOR FAILED PT INO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 "t 3; 4 5 6 DATE ACTION TAKEN: / / <br /> SITE NAME L2 C O I <br /> ADDRESS <br /> CITY =� G, � ,ct _ STATE ' 2IP <br /> CONTACT NA14E z(�C PHONE <br /> PROPERTY OWNER ` <br /> COMPANY NAME /1 /� PHONE h <br /> CONTACT NAME ( I Com' PHONE <br /> ADDRESS �, /�C � <br /> CITY rte.S ( �� STATE c/� ZIP 1 '?0 -769- 6i�)3F <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 # G�V �/� DATE 7�C�— PROP 65 # DATE 7-6 — ?9 PRIORITY <br /> STREET # 132 i � SITE STREET / � �� r �l{ t� APN <br /> EH 23 070 (7/89)" 1 89-19(IV) CNTMFR2 1, REVISED 12/94 <br />