Laserfiche WebLink
PHS/S1Ltt JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISTK <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM A <br /> UPDATE: / / 2'r / �� BY: � REVIEWED BY TE ENTERED: O% -/ BY: <br /> SWEEPS/SITE CODE 1 �� PROGRAM/ELEMENT Z!'sQ COMP �! LOC CODE DIST # 32 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE FTPRIV WELL FILE ENV ASSESS <br /> SOLID WASTE 1120 O FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWQCB CONTACT WOR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT GW CONI DW CONT �ETROLEUM Y / N <br /> SUBSTANCE #1 #2 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION ICLEAN UP COMPLETE DATE ENFORCEMENT ACT=011Y <br /> N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS (/��/� .� <br /> CITY STATE ZIP <br /> —3 <br /> CONTACT <br /> CONTACT NAME (/l �4 4 PHONE �G3 , !2-/��s 12,0 O <br /> PROPERTY OWNER �} <br /> COMPANY NAME ,�S R• e J`f / PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE �j� ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME �, �Iy� F � � PHONE <br /> CONTACT NAME G/JA � PHONE <br /> ADDRESS 64d �1i� (1 <br /> CITY /.� STATE L/T ZIP <br /> 4v <br /> CONSULTANT �- PHONE <br /> UPR # DATE PROP 65 # 'j,b 1 DATE .Zr l PRIORITY d <br /> STREET # 7f J SITE STREET � 5 1 APN # / -124,(Q 9 <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 ✓ <br />