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PHLS JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVOI <br /> G7 .meq CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / /ABY: �y� REVIEWED BY: DATE ENTERED: q /)0 / BY: <br /> SWEEPS # 7�,[ SITE CODE COMP # 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/ELEMENT a �,D LEAD AGENCYNNIT SJ/EH CONTACT <br /> RWOCB CONTACT DHS CONTACT OTHER CONTACT <br /> FAILED PT SOIL CONT GW CONT �O DW CONT PETROLEUM Y / N <br /> SUBSTANCE #1 1a 03 Ip #2 #3 O #4 #5 <br /> PRIOR FAILED PT f 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 PHONE <br /> r <br /> ADDRESS <br /> CITY _!_.� _�- STATE 21P <br /> CONTACT NAME •1 �� 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 # DATE PROP 65 # DATE PRIORITY <br /> STREET # SITE STREET APN # <br /> EH 23 070 (7189)REVISED 01/91 89-19(IV) CNTMFR2 <br />