Laserfiche WebLink
a <br /> PHS/'l `,OACUIN COUNTY - ENVIRONMENTAL HEALTH DIVIkwkS <br /> NTAMINATED SITE D-Base MFR - INPUT;'FORM <br /> �] �! <br /> UPDATE: BY: REVIEWED BY: <br /> ! DATE ENTERED: / / 8Y: <br /> SWE-EPS/SITE COD �D D PROGRAM/ELEMEITO�Dl <br /> O COMP # �f 0/� LOC CODE �/ DIST # <br /> 2-1 <br /> UGT FiLE PILOT FILE H W FILE SITE MITIGATION PWS .F[LE Ik PRIV WELT. FILE <br /> I ENV ASSESS <br /> SOLID WASTE H2O 4 FILE EPI FILEF7 LAND USE FILE OTHEPI�AGENCYIREPORT <br /> II EMERGENCY RESPONSE <br /> 3 Ip w <br /> LEAD AGNCY/UNIT SJ/EH CONTACT OHS CONTACT -.. <br /> OTHER CONTACT R1QC3 CONTACT WOR issued Y / N NPOES issued Y / N <br /> T � i <br /> FAILED PT / [1 �� SOIL CONT 5/�j �J GW CONT I DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 1�3/ #2 Izc>-3q 1#3 94F <br /> #5 <br /> PRIOR FAILED PTNO ACTION CLEAN UP COMPLETE IV IGATE } <br /> I ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAE <br /> ADDRESS l�/ � �,/�/J/T, l <br /> / (/{J Vi/tGilr'L 6 I <br /> CITY --{�, STATE Itl ZIP (75201 <br /> CONTACT NAME ! iJ I <br /> ;i PHONE <br /> PROPERTY OWNER it I <br /> COMPANY NAMEa/r !/\n/} // C PHONE <br /> !.0ITS !! <br /> CONTACT NAME / n' I�� j/, e n � �j I PHONE <br /> LfJV V 1.c/v 1 <br /> ADDRESS <br /> CITY STATE I �p 2IP <br /> RESPONSIBLE PARTY (If different from Property Owner) 1 b <br /> r1l <br /> CCMPANY NAME PHONE <br /> I <br /> CONTACT NAME I PHONE <br /> ADDRESS f� <br /> > F I <br /> I <br /> CITY STATE ZIP <br /> i <br /> CONSULTANT I PHONE <br /> UAR n DATE !Q PROP 65 # DATE 111 / PRIORITY <br /> i8 qi <br /> STREET # SITE STREET v v ve h � <br /> � APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />