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i <br /> Pna/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIv1SION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORMAl- <br /> UPDATE > BY REVIEWED BY DATE ENTERED _ `� BY <br /> �i ADDITION:_ EDIT• <br /> SWEEPS # SITE CODE CCMP # LOC CODE / DIST # 2 <br /> UGT FILE PILOT FILE H W FILE/ SITE MITIGATION PWS FILE PRIV WELL FILE I ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT H W SPILL/DISPOSAL <br /> PROGRAM/ELEMENT LEAD AGENCY/UNIT c(J ea),�Q c,, SJ/EH CONTACT <br /> RWQCB CONTACT DHS CONTACT OTHER CONTACT <br /> FAILED PT PNOACTIOON'L <br /> CONT j (p-17-?S GW CONT lO��7-/',Z DW CONT PETROLEUM Y / 0 <br /> PRIOR FAILED PT CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME V6;krkk- <br /> PCLC(,. <br /> tC- �r PHONE <br /> ADDRESS Va� &,L �A /�,/ ,,d5G <br /> CITY s STATE � ZIP <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME C—/L 0-� PHONE <br /> CONTACT NAME �s /�� / - <br /> PHONE <br /> ADDRESS D <br /> CITY STATE ZIP C �� <br /> RESPONSIBLE PARTY (If different from Property Owner) �' I 6 <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE Cj�dZIP S�Q <br /> CONSULTANT o S n ( PHONE c,, <br /> UAR # DATE , PROP 65 # cg > DATE !� PRIORITY <br /> STREET # SITE STREET 1 /Q� �('0��� APN # <br /> EH 23 070 (7/89)REVISED 11/90 89-19(IV) CNTMFR2 �/VV <br />