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PHS, <br />/rJ, <br />/2 / 7/ / BY: <br />// 5-17 <br />UPDATE: /?/ BY: <br />JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI <br />CONTAMINATED SITE 0-Base MFR - INPUT FORM <br />./ <br />REVIEWED BY: DATE ENTERED: <br />SWEEPS/SITE CODE -;-;(-: -----' -, ?. PROGRAM/ELEMENT -->(/ = - -‘ COMP # _- 4 4/,,,ci, LOC CODE ' 01ST # <br />' 7,---- <br />UGT FILE PILOT FILE H W FILE SITE MITIGATION 5.;.; PWS FILE PRIV WELL FILE ENV ASSESS L_ <br />SOLID WASTE H20 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br />LEAD AGNCY/UNIT On- Ple)q (0 <br />SJ/EH CONTACT //171,e....4,4 DHS CONTACT <br />OTHER CONTACT RWOCB CONTACT WDR issued Y / N NPDES issued Y / N <br />FAILED PT SOIL CONT i GW CONT 4.2..)7,7c..., OW CONT PETROLEUM /0/ (1,1 <br />#5 <br />) <br />SUBSTANCE #1 c/416 #2 7.2b3g2,--- #3 #4 Z//t..„/"....- - <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 --77,/ <br />--) / <br />JP' - <br />ADDRESS ...20 / k// /1///4; <br />' ,-- <br />I il..er / -, <br />CITY STATE 6/4_. ZIP C-----;----) ./ 5 <br />-. ---) ' - <br />CONTACT NAME PHONE <br />PROPERTY OWNER <br />COMPANY NAME <br />‘r2V17 <br />PHONE <br /> LiZ7 Ii-Th <br />CONTACT NAME 2 .26 J/ 4,_...- PHONE <br />ADDRESS <br />i <br />CITY <br />/ . / STATE ZIP ---3 / <br />RESPONSIBLE PARTY (If different from Property Owner) <br />COMPANY NAME ,i1e,7J0.76.e....4"&4.... )2/,_elie9- PHONE <br />CONTACT NAME D' 6-a-tAi-L PHONE /3 yi,‘ 4545' <br />ADDRESS 7 0'0 Eet-417e <br />CITY STATE ot ZIP o 77C/F <br />CONSULTANT <br /> V Zn-es-Z. <br />PHONE <br /> <br />UAR # DATE PROP 65 # V__,19143g DATE 5,1542., PRIORITY <br />STREET # c7. 2(2 / SITE STREET C.e/ /7-1 ze----/ e2---, <br />APN # <br />EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2