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PHS,_–rj JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DTVI—JN <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE ` BY REVIEWED BY DATE ENTERED '/ BY <br /> / ADDITION• EDIT: U <br /> SWEEPS # J SITE CODE COMP # LOC CODE / A DIST # 3 <br /> UGT FILE / PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FI/LE / ENV ASSESS <br /> SOLID WASTE H2O Q FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT PETROLEUM Y / N <br /> PROGRAM/ELEMENT z C1 LEAD AGENCY/UNIT SJ/EH CONTACT <br /> RWQCB CONTACT DHS CONTACT OTHER CONTACT <br /> FAILED PT SOIL CONT GW CONT DW CONT H W SPILL/DISPOSAL <br /> ADDITIONAL FAILED PT NO ACTION CLEAN UP COMPLETE + DATE q G7 / ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: ! / / / <br /> SITE NAME ,/f PHONE <br /> ADDRESS <br /> CITY f— ✓✓✓ STATE ZIP 9 S � <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE <br /> CONTACT NAME / �J� PHONE <br /> ADDRESS Y <br /> CITY STATE C� ZIP r�6 <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # DATE PRIORITY <br /> STREET # SITE STREET !,, / APN # <br /> EH 23 070 (7/89)REVISED 11/90 89-19(IV) CNTMFR2 <br />