Laserfiche WebLink
PHS/S 'JIM COUNTY - ENVIRONMENTAL HEALTH DIVISI` <br /> —% 4A INATED SIT!D-8ase MFR - INPUT FOR14 '�.r► <br /> UPDATE: / Z C, / BY: REVIEWED BY: !T. A DATE ENTERED: / / ��2 BY: <br /> SWEEPS/SITE CODE /Z/d 7 PROGRAM/ELEMENT CCMP # M(O 2 2- LOC CODE a( DIST <br /> UGT FILE LOP <br /> �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 WOR issued Y / N MP issued Y / N <br /> FAILED PT / / SOIL CONT S /2-6- /,?Z_ GW CONT / / OW CONT PETROLEUM / N <br /> SUBSTANCE 91 a #2 Z C)-3 / <br /> 93 #4 #5 <br /> PRIOR FAILED PT d NO ACTION CLEAN UP COMPLETE DATE / / ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAMEV C�11 `G zG4 <br /> \ <br /> ADDRESS z 2 -7 Z Z F'1•�� ` / <br /> CITY \ STATE IIP S /• <br /> O b <br /> CONTACT NAMEI ` G c� PHONE <br /> PROPERTY OWNERI <br /> COMPANY NAME I i j 4 l I U` PHONE y,IS -76 <br /> CONTACT NAME PHONE <br /> ADDRESS '")GC�) � IflCG �• <br /> CITY o� 1_ n (q�Ce C J STATE ZIP Fq <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> S N'I L <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATE- PROP 65 # ? :. DATE .5^ _ PRIORITY <br /> STREET # 2Z7ZZ SITE STREET. 9 C, APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19 CNTMFR2 <br />