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PH', 1 JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV, d <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / 2�/99 BY: �A, REVIEWED BY: DATE ENTERED: O( /!/ / BY: <br /> SWEEPS/SITE CODE 9 PROGRAM/ELEMENT 2 95'6 CCMP # LOC CODE O DIST # 52-2- <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 EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT 15 ,u�. A 554-4 � SJ/EH CONTACT �IV/4--2t�je 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 #1IZ11z <br /> #2 I t#3 #4 #5 <br /> PRIOR FAILED PT NO Af- C ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME / n <br /> AC DRESS <br /> CITY ./ STATE C� C ZIP <br /> CONTACT NAME 6 PHONE <br /> PROPERTY OWNER <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 # DATEPROP 65 # DATE PRIORITY <br /> - I <br /> STREET # / (�G SITE STREET E� N [APN # <br /> EH 23 070 (7/89)REVISED /03/91 89-19(1V) CNTMFR2 <br />