Laserfiche WebLink
PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH I. SION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / -7 /Cis BY: REVIEWED BY: DATE ENTERED: / / -`� BY: / <br /> /. <br /> SWEEPS/SITE CODE �i �� PROGRAM/ELEMENT G�� j COMP # LOC CODE D4 # 3 <br /> UGT FILE LOP/FILE H W FILE SITE/MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLIDWASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> IL- <br /> LEAD AGNCY/UNIT �C SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT J 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 1 1 #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 <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONTACT NAME 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 i/ PHONE �1 G� C s—_2 ��,3 <br /> ADDRESS <br /> C�- <br /> CITY STATE ZIP / s <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # DATE PRIORITY <br /> STREET # SITE STREET — JAPN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />