Laserfiche WebLink
PHSJOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI� <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / �5 / q( BY: G G REVIEWED BY: DATE ENTERED: �/ /q( BY: <br /> SWEEPS/SITE CODE 7z- PROGRAM/ELEMENT Z 7 COMP # l�tj JD ;- LOC CODE 4-) ( DIS # <br /> UGT FILE PILOT 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 EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT Ulf rrIU- SJ/EH CONTACT �R(L c.,/ DHS CONTACT - <br /> OTHER CONTACT RWOCB CONTACT WOR issued Y / N NPOES issued Y / N <br /> FAILED PT /_��/_lC{( SOIL CONT GW CONT DW CONT ETROLEUM d)/ N <br /> SUBSTANCE #1 #2 0 1 1 #4 1 #5 <br /> PRIOR FAILED PT NO ACTION16 1 CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME 154a ` r4 JI N <br /> ADDRESS Z 2 Z WC:jE,00- <br /> CITY 57Yl4-14TYJA.1 I <br /> STATE G� ZIP `LO `L <br /> CONTACT NAME PIC([L- PHONE 4(65s - 2-061? <br /> PROPERTY OWNER <br /> COMPANY NAME '%4N "�7�Q(Jf COV/ T' PHONE <br /> CONTACT NAMEw;r4- PHONE i//'S_ .)0!g <br /> ADDRESS 22 Lt/ -[!'� <br /> CITY C!57z9L,l,-Ya/,,t STATE ZIP C-OZ- <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # cr� L� DATE tj((j�(G( PROP 65 # 4!, DATE sl/S`y( PRIORITY <br /> STREET # ZZZ SITE STREET A P N # Z- <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />