Laserfiche WebLink
PHS/S*OUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIC� <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: '3 1-3 / BY: r REVIEWED BY: DATE ENTERED: Y / /Gl� BY: <br /> SWEEPS/SITE CODEf g , PROGRAM/EtEMENT Z-3 �� CCMP it ��AR1�r [LOC CODE fN� DISC •3 Z <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PUS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORTEMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT Rw Qt T SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWQCB CONTACT cE1'N'1 WJ/��� S FWE)R_issued Y / N NPOES issued Y / N <br /> FAILED PT �r��r�/(fJ SOIL CONT GW CONT OW CONT ETROLEUM U/ N <br /> SUBSTANCE #1 03 #2 #31 i #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> fORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME D� NSC s�Jcs P�e7c n1 P, 015414a-ba") - ld- C I—AADA <br /> ADDRESS Nv/1d�w1l,v/+x/ ! d;PC�/�N OF /C� R/o� �'`I �✓5G' S /GN7J0� P N `✓PS� <br /> 960001 310c STATE CQ ZIP QJ�C16 —0250 <br /> CONTACT AMAbel W, a/AJez PHONE COQ _98Z _-q0Q0 <br /> PROPERTY NER <br /> COMPANY NAM PHONE <br /> CONTACT NAME 1 vv / PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> RESPONSIBI PARTY (If different from Property Owner) <br /> COMPANY N E PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> L <br /> UAR # DATE j�r f f PROP 65 # DATE -3//3 � PRIORITY <br /> STREET # —SITE STREET � Lj APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />