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1 <br /> PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL 1.---LTH DIVIS.--m <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: S / �� / BY: REVIEWED BY: DATE ENTERED: / / BY: <br /> SWEEPS/SITE CODE F\ PROGRAM/ELEMENT d COMP # LOC CODE "(� DIST # <br /> UGT FILE ) LOP FILE � H W FILE �; SITE MITIGATION PWS FILE PRIV WELL FILE ��! ENV ASSESS Z <br /> SOLIDWASTE N20 0 FILE 1 EPI FILE �: ! LAND USE FILE OTHER AGENCY REPORT !,\ EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT <br /> OTHER CONTACT RWOCB CONTACT WDR issued Y / N NPDES issued Y / N <br /> FAILED PT / / SOIL CONT / / GW CONT / / DW CONT PETROLEUM Y / N <br /> SUBSTANCE #1 #2 #3 #4 #5 <br /> PRIOR FAILED PT 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 ��' / <br /> ADDRESS <br /> CITY 1111 STATE ZIP <br /> CONTACT NAME 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 jI PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT G \ , - PHONE <br /> UAR # DATE PROP 65 Tv <br /> I — <br /> DATEPRIORITY <br /> STREET # SITE STREET TAPN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />