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pa � � 2 <br /> PHS/SAH JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE D - Base MFR - INPUT FORM <br /> UPDATE : 16 / to / C�(,� BY : PVLtaa J REVIEWED BY : DATE ENTERED : <br /> tt <br /> SWEEPS/SITE CODE 'JJ (�.� t- �� PROGRAM/ELEMENT r r COMP # LOC LODE p?) I DIST 61E55 <br /> UGT FRE PILOT FILE H W FILE SITE MITIGATIONW FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O O FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE - <br /> LEAD AGNCY/UNIT kW QCB SJ/EH CONTACT ^ n DNS CONTACT <br /> OTHER CONTACT RWOCB CONTACT n'lo S L." tc yr �/ WDR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT f ' , GW CONT rAJ DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 42 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACT1DIF / N <br /> ENFORCEMENT TYPE : 1 2 3 4 5 6 DATE ACTION TAKEN : /_/ / <br /> SITE NAME CC U*I LC I <br /> ADDRESS 2�G0p <br /> CITY STATE ZIP <br /> CONTACT NAME �� � C[. PHONE Czo -J � 1 / 50 <br /> PROPERTY OWNER <br /> COMPANY NAME � . /1 /�C ' LU S PHONE <br /> CONTACT NAME c PHONE C� p q)1 Kik <br /> ADDRESS ,fib <br /> CITY / STATE ZIP <br /> RESPONSIBLE PARTY ( If different from Property Owner ) < ✓ Z <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITYV,n1f STATE ZIP <br /> CONSULTANT l l L-iJ 1r, . ^ Dick ( PHONE <br /> UAR # DATE PROP 65 # DATE 1, PRIORITY <br /> STREET # SITE STREET APN # <br /> EH 23 070 ( 7/89) REVISED 03/91 89- 19( IV) CNTMFR2 <br />