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AN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D �VON <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATEBY REVIEWED BY DATE ENTERED / BY // <br /> ADDITION: EDIT: <br /> j �-i� <br /> L= <br /> SWEEPS # <i/_ SITE CODE COMP # LOC CODE DIST # <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 PETROLEUM Y / N <br /> FAILED PT SOIL CONT GW CONT DW CONT H W SPILL/DISPOSAL <br /> ADDITIONAL 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 /> PROGRAM/ELEMENT 2- `f9 I <br /> LEAD AGENCY/UNIT SJ/EH CONTACT <br /> RWOCB CONTACT <br /> 1,� DHS CONTACT OTHER CONTACT <br /> SITE NAME - HONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONTACT NAME ,J/ PHONE <br /> PROPERTY OWNER <br /> r <br /> COMPANY NAME PHONE <br /> CONTACT NAME ,rye /G PHONE <br /> ADDRESS ✓�� <br /> CITY GL STATE ZIP <br /> RESPONSIBLE PARTY (If different fr Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT /' PHONE <br /> UAR # t-- DATE PROP 65 # DATE PRIORITY <br /> STREET # SITE STREET HAPN # <br /> EH 23 070 (7/89)REVISED 11/90 89-19(IV) CNTMFRI <br />