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�r <br /> PHS/" CAGUIN COUNTY - ENVIRONMENTAL HEALTH OtVIS[ <br /> .ONTAMINATED SITE D-Base MFR INPUT FORM <br /> UPDATE: ! / BY: REVIEWED BY: DATE ENTERED: d 7/ 67 /?3 BY: <br /> 3aa 4 t� PROGRAM/ELEMENT a g� CAMP 'tlevr:a�3/S loe CODE <br /> S6,E=-PS/SITE COO EC)/ DIST s 3 3 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATI(PJ PWS FILE PRIV WELL FILE ENV ASSESS <br /> =EPtFILEWSOLID WASTE H2O 0 FILELAUSE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> ----[ n - H <br /> LEAD AGHCY/UNIT WEN CONTACT F C? DNS CONTACT -- <br /> OTHER CONTACT RWOCS CONTACT WDR issued Y / N NPOES issuedFY /' <br /> N <br /> FAILED PT SOIL CONT T OW CONT ETROLEUM �/ - H _ <br /> SUBSTANCE 01 3.;' — <br /> "2 /(26, y;�-3 93 194. A5 <br /> f a-o <br /> PRIOR FAILED PT �TNO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / H _ <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> -s nG - <br /> ADDRESS /sl c( f', SGv�> s /�u-e- <br /> CITY . <br /> 4-v STATE ZIP Q 5 2-v <br /> S� �lcr <br /> CJNTACT NAME h rtr2 UO rc G S PHONE S- Y(o (a -07a S- <br /> -- <br /> PROPERTY OWNER <br /> COMPANY NAME l 0 <br /> PHONE �U g _�(�6 -0 <br /> r hd -s �i�c <br /> CONTACT NAME ) r PHONE �V eJ - t2/(o&- <br /> ADDRESS P �O 3&8-F <br /> STATE N <br /> CITY SltU/ - f <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> PHONE <br /> COMPANY NAME S �� <br /> ' <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> PHONE <br /> C'NSUliAN7 <br /> UAR / 3 U-�-/ OATS ^7-y 3 PCP 65 s y3-G�.9 DATE �_ 7_y 3 PRIORITY <br /> STREET R !S t SITE STREET S C O f f S /i t�P. APN <br /> EH 23 070 C7/89)RN1SZD 03/91 89-19(IV) CYTMFRZ <br />