Laserfiche WebLink
PHS/SAN,.,,iDUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIC�� <br /> CONTAMINATED SITE DL-Base MFI - INPUT FORM q <br /> UPDATE: 3 / ID /q 4 BY: REVIEWED BY: lYW DATE ENTERED: a3/ Y / / ( BY: 7110 <br /> SWEEP /SITE C PROGRAM/ELCOMP # LOC CODE 0/ DIS( # <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATIONllf PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O D FILE EP[ FILE LAND USE fiLE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT Z-() P DHS CONTACT <br /> OTHER CONTACT V IOC RWOCB CONTACT WDR issued Y 1 N NPDES issued Y / N <br /> FAILED PT �•c• SOIL CONT 3-q-q 4 GW CONT OW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 I Z.D3 I #2 #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 <br /> ADDRESS J 767 , /w, 1. <br /> CITY V /'�( ' 7�y1 STATE ZIP <br /> CONTACT NAME PHONE g 3�� 6009 <br /> PRCPERTY OWNER <br /> COMPANY NAME <br /> �I e C �-y)T/'!✓- PHONE q3 <br /> V (J7 LAG`' <br /> CCNTACT NAME PHONE <br /> /� J,, 2 PHONE <br /> ADDRESS ✓ <br /> V /(/I �ljY� �W�jjyl I <br /> CITY STATE/VA.n�• STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) v <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE Z[7 <br /> CONSULTANT ,/ ''\\ �7 PHO�NIE <br /> UAR # v15 DATE 3 4V-q� PROP 65 .� DATE 3���'y`� PRIORITY <br /> STREET �L SITE STREET APN # <br /> EH 23 070 (7/89)REVISED 03/91 89.19(IV) CNTMFR2 <br />