Laserfiche WebLink
PHS/ JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI; <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / � BY: REVIEWED BY: W DATE ENTERED: / / BY: r <br /> 19 <br /> ILL <br /> SWEEPS/SITE CODE - F PROGRAM/ELEMENT 1� � CCMP # St 'K`� LOC CODE r DISjil �I '??r <br /> # �a <br /> UGT FILE PILOT FIL 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 SJ/EH CONTACT DHS CONTACT - <br /> OTHER CONTACT RWOCB CONTACT a WDR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT GW CONT DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 0 4 3 � #2 _ #3 •f J � #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5/ 6 DATE ACTION TAKEN: <br /> SITE NAME v` G� GGYu�iP�`�C` �(S ^(C <br /> ADDRESS <br /> CITY DGfC / l STATE ZIP 9Sa0�5 <br /> CONTACT NAME �4�t���j�� PHONE a6 Q (fes �D 7� <br /> PROPERTY OWNER J`/vcJ <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <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 # 3fD DATE PROP 65 # 1��1 \ DATE �J- PRIORITY <br /> STREET # J a SITE STREET // ! APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />