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PHS/SO) <br /> AOUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS10 <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: l / y; /�I BY: r_.� REVIEWED BY: '� DATE ENTERED: 0/ !� 9 / BY: <br /> SWEEPS/SITE CODE PROGRAM/ELEMENT "�.. �� CCMP # LOCCODEDIST # <br /> UGT FILE % LOP FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O D FILE 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 ' #5 <br /> PRIOR FAILED PT NO ACTIONII <br /> CLEAN UP COMPLETE DATE / / ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <-- <br /> �,u <br /> ADDRESS <br /> CITY C' STATE I,-� ZIP <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME - - PHONE <br /> I c 1" <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE `j ZIP <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 # (�G DATE h � PROP 65 # DATE PRIORITY <br /> STREET # II SITE STREET Ai :) , APN # <br /> EH 23 070 (7/89/)REVIS)))ED 03/91 89-19(IV) CNTMFR2 <br />