Laserfiche WebLink
sus :CAOUIN LwRTY - EWITRCHNEHUL 11MLH Dt ax <br /> CCNTAMIHATED SITE 1-3az MFR INPUT FORM <br /> / cv - DATE ENTERED : / ! d7 : <br /> LTDAIE : q / / dY • REVSEG'EJ d-77: r ,, <br /> 5:EEPSJSIT'e CODE �.Jn � p LP I PROG7Ni/ELEI7EHT a ^ Y � CQIP Y LOC CODE 17 9 0I5T Y <br /> UGT FILE I PILOT FILE H V FILE ( SITE✓41TIICATION PUS FILE I PRIV YELL FILE ENV Assess <br /> SOLD 114ASTE H2O D FIL'c I EPI FILE- LAND USE FILE I OTHER AGENCY REPORT I I E'lammCY RESPONSE <br /> = • D AGRCY/UNIT: G( � 51/EA CCNTACT 4 ORS CONTACT <br /> i <br /> iRUOCH CONTACT wait issued T / N I MMES issued Y / N <br /> CONTACT , <br /> FAIlEO PT I I SOIL CONT I/ ��� - 9 � CD COAT IOu CRIT ETROLELTI - t�F Y 1 / N <br /> ti'aSTANC= Yl =� IDS, <br /> ! T FJIFORCSIEHT ACTION T / N <br /> P41^_R FAILED PT I NO ACTION � CLEAN UP COMPLETE � DATE . <br /> EIIFORG-'1QIT T7PE: 2 3 4 5 5 DATE ACTION TAKEN: _/_/__ <br /> i <br /> 40RESS I S� q�� � //-} <br /> CITY I S 1 D I V i `� I STATE I C / I ZIP <br /> .INTACT NAMEI - DIVi QT 019 'TE PHONEo <br /> PZCPERTY CL'NE3 /'/n/n <br /> =PPANY !NAMEvaim <br /> GIS�Cr -i <br /> 7;:NTAC', NAME PHONE <br /> n <br /> }➢DRESS r� C.l'^ / <br /> CITY I 1 �D STATE I C I ZIP �� Q Cp <br /> ._S7C4SIBLE PARTY ( If different f✓r PropeM 0w r) <br /> MPANY NAME PHONE <br /> u.NTAC NAME r PHONE I - <br /> ADDRESS <br /> CITY. I STATE I ZIP <br /> =1SUL'AHT I - I PHONE <br /> }R Y DATE I � �U U PRCR y} lYh �l ✓ � DATE y �� 7I PRIORITY <br /> -aEET. % 12l 5' T' STREET Ie / / Q c Q do / /APH <br /> 73070 ( 7189 )" 89-.I9(Iv) CNTHER2 C.�. REVIESED 12 / 94 <br />