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7 7 / PHs/L JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS <br /> CONTAMINATED SITE D-Base MFR INPUT FORM !!� <br /> i <br /> UPDATE /a> BY REVIEWED BY DATE ENTERED _ G�fCJ 7 BY <br /> (l/ ADDITION: /� EDIT: <br /> SWEEPS # SITE CODE � — �� CCMP # LOC CODE / DIST # <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 H W SPILL/DISPOSAL <br /> PROGRAM/ELEMENTLEAD AGENCY/UNIT �(��(,(/Q G� SJ/EH CONTACT <br /> RWOCB CONTACT DHS CONTACT OTHER CONTACT <br /> FAILED PT SOIL CONT — 7 Z GW CONT (O 7'/Z DW CONT PETROLEUM Y / (� <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 l /l�5 Oa I �C c— r o �r PHONE <br /> ADDRESS YO Z IV. 1—//V60ZA 5-7z ,r�lZ/1C 61GliLf�+�. „ <br /> CITY STAT ZIP <br /> CONTACT NAME ���/ PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME O� PHONE <br /> CONTACT NAME ,/ PHONE <br /> ADDRESS <br /> CITY STATE <br /> RESPONSIBLE PARTY (If different from Property Owner) / <br /> COMPANY NAME 1 PHONE <br /> 04— c—L�o V-\ <br /> CONTACT NAME /� PHONE <br /> ���YYY/// v <br /> ADDRESS ZO N { ,� ��� �y- E•�J <br /> CITY / ( STATE ZIP <br /> CONSULTANT S PHONE <br /> UAR # DATE PROP 65 # /_2') ,u DATE f� PRIORITY <br /> STREET # D 2 SITE STREET Q� / �jj�„_ APN # /3 7. 1��. . <br /> EH 23 070 (7/89)REVISED 11/90 89-19(IV) CNTMFR2 / O <br />