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PI A:JOAOUIN COUNTY - ENVIRONMENTAL HEALTH 01 IN <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: Z BY: ,!!:5' REVIEWED BY: �,� ,) DATE ENTERED: // / y BY: <br /> SWEEPS/SITE CODE Jf PROGRAM/ELEMENT Z Z COMP # vp Z /LOC CODE DIST�j <br /> 2 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT - - <br /> OTHER CONTACT RWQC8 CONTACT WDR issued Y / N NPDES issT.dY / N <br /> FAILED PT SOIL CONT GW CONT OW CONTETROLEUM / N <br /> SUBSTANCE #1 'ZCJ �j #2 j Z j. #3 94 #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 L/. �� i/ ;/`+ <br /> ADDRESS <br /> CITY � r�GSTATE ZIP �! Z 3 7 <br /> CONTACT NAME � �(GY/� PHONE <br /> PROPERTY OWNER / <br /> COMPANY NAME I,// _ ��� p� ��L, O�- PHONE {-7l6 ) L�L ' ��floj <br /> CONTACT NAME ,p PHONE <br /> ADDRESS <br /> CITY /� V/ STATE RIP <br /> RESPONSIBLE PARTY (If different from Property Owner) uu <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # 672 DATE Z �� PROP 65 # °1 l�Z U DATE 3 Iq PRIORITY <br /> STREET # QUO SITE STREET !/ra� 1 APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 //lam <br />