Laserfiche WebLink
PIIS/-UJOAOUIN COUNTY - ENVIRONMENTAL IIEALTH QIVIS <br /> CONTAMINATED SITE D-Base MFR INPu'f FORM <br /> UPDATE:3 / 15q BY �N� REVIEWED BY: DATE E!JTERED: 11-MA S BY: <br /> SWEEPS/SITE CODE Q� AROGRAMfELEMENT a3 CgHp # I LOC CODE DIST <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FI !E PRIV WELL FILE ENV ASSESS <br /> IL SOLID WASTE 1120 0 FILE EPI FILE LAND USE FILE OTHERfAGENCY REPORT' EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT � � SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT <br /> R1�UC8 CONTACT WOR Issued Y /� NPDES issued Y / <br /> FAILED PT SOIL CONT (� ! f - GW CONT DW CONT IP <br /> ETROLEUM ( YJ / N <br /> SUBSTANCE #1 3 #2 #3 :i #4 #5 <br /> r <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE i� ENFORCEMENT ACTION Y / N <br /> EIIFORCEMENT TYPE: 1 2 3 4 5 b DATE ACTION TAKEN: <br /> F <br /> SITE NAME C <br /> ADDRESS <br /> CITY STATE F C ZIP l�3 <br /> U ,I PHONE 7" � <br /> =CONTACTME I� <br /> PROPERTY OWNER <br /> s <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> `f <br /> ADDRESS <br /> I <br /> CITY STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> h <br /> S <br /> COMPANY NAME j x , r PHONE r <br /> k <br /> CONTACT NAME PHONE <br /> ADDRESS , `F <br /> CITY STATE .i ZIP CJS3 <br /> 1c0f—jSUL <br /> TANT <br /> s PHONE <br /> �I <br /> T- <br /> UAR # DATE /lPROP 55 # �/�/I DATE PR E OR 1 TY } <br /> STREET # 10 OD SITE STREET �f� \7 FJ APNI# <br /> �4 <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br /> 'I <br /> 4 <br />