Laserfiche WebLink
PHS/S OAOUIN CCUNTY - ENVIRONMENTAL HEALTH DIVIS7 <br /> -k;NTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: ( 12 2— /9 ZBY: REVIEWED BY: DATE ENTERED: / / BY <br /> SWEEPS/SITE CODE PROGRAM/ELEMENT 21- b COMP # LCC COLE lo DIST # L <br /> UGT FILE LOP FILE H W FILE SITE MITIGATICN PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE TLAND USE FILE OTHER AGENCY REPCRT T7 <br /> EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT ✓ SJ/EH CONTACT DHS CONTACT <br /> OTHER CCNTACT ✓ RW0CS CONTACT WOR issued Y / N NPOES issued Y / N <br /> FAILED PT / / SOIL CCNT / / GW CONT / / OW CONT PETROLEUM Y / N <br /> SUBSTANCE #1 #2 #3 #4 15 <br /> PRIOR (AILED 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 WCJ STATE d( ZIP <br /> CONTACT NAME CSC`c�c �(J FPHCNE , U <br /> PRCPERTY OWNER <br /> CCMPANY NAMEle�?( <br /> T PHONE <br /> CONTACT NAME PHONE -eel- 2 <br /> ADDRESS _ 3 S -LL �• /D - <br /> CITY STATE ZIP <br /> r <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME _ PHONE <br /> CONTACT NAME �L PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATE PRCP 65 # T DATE PRIORITY Q <br /> STREET # SITE STREET a (f <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 // <br />