Laserfiche WebLink
PHS/' JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS- <br /> ONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: // qz BY: REVIEWED BY: DATE ENTERED: // / /�/�� BY <br /> v i ��, <br /> SWEEPS/SITE CODE G1 2?,� PROGRAM/ELEMENT Z9�"D COMP # LOC CODE DIST # <br /> UGT FILE LOP 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 I JEMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT OHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WDR issued Y / N NPDES issued Y / N <br /> FAILED PT / / SOIL CONT / / GW CONT / / DW CONT PETROLEUM Y / N <br /> SUBSTANCE #1 #2 #3 94 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE / / ENFORCEMENT ACTION TY <br /> / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS 4/ i1 <br /> CITY /I b /L/ <br /> STATE ZIP <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER / G <br /> COMPANY NAME /,, , {— �C�2 vA-aL t�, PHONE <br /> CONTACT NAMEl l PHONE z/0- y�1- <br /> ADDRESS <br /> CITY O� D a STATE e ZIP z /� <br /> i <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT 0('r—n �*i V t.7 W,W PHONE <br /> UAR # DATE ` PrROP 65 # DATE PRIORITY <br /> STREET # 41 SITE STREET �U j�kWYI/ FAPN # 2/ / f Z�� l <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />