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.PHWAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH Div low <br /> WAMINATED SITE D-Base MFR - INPUT FORM <br /> - - 5 <br /> UPDATE: ' / BY:' :' % REVIEWED 8Y: ' " .. DATE ENTERED: pt/i I 6 1993 BY- <br /> _ 4 <br /> SWEEPS/SITE CGDE PROGRAM/ELEMENT CCNP ! p LOC CODE 77 DIST • <br /> f <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT OHS CONTACT - <br /> OTHER CONTACT RWGC8 CONTACT WDR issued Y f N NPDES issuedY / N <br /> FAILED PT SOIL CONT �a' �� CJ GW CONT OW CONT �ETROLEUM ! N <br /> SUBSTANCE #1 1�.J #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 /> SITE NAME Ji C <br /> ADDRESS <br /> al 6 <br /> CITY STATE UFT ZIP 9Soz.3�o <br /> CONTACT NAME js � QQ, ` C-. PHONE �Nf 33 <br /> PROPERTY OWNER <br /> COMPANY NAME . PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS / O 7 <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 PROP 65 # DATE PRIORITY <br /> STREET # �.i5 1 SITE STREET C�CAPN # <br /> EN 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 J <br />