Laserfiche WebLink
PHS/SA.,AOUIN COUNTY - ENVIRONMENTAL HEALTH DIVISI.v <br />CONTAMINATED SITE D -Base MFR - INPUT FORM <br />UPDATE:l/fFJ / G� / BY:1yp^N�tEVIEUEO 8Y: DATE ENTERED: / / BY: <br />TWEEPS/SITE CODE <br />/� <br />PROGRAM/EL ENT �J Y� <br />COMP # <br />(� g�/ /� <br />LOC CODE1 <br />oil <br />DIST # <br />?'L <br />UOT FILE <br />- <br />PILOT FILE <br />/ <br />H W FILE <br />SITE MITIGATION <br />RWVCS <br />PUS FILE <br />#4 <br />PRIV WELL FILE ENV ASSESS <br />WOR <br />SOLID WASTE <br />Y / N <br />H2O 0 FILE <br />issued <br />EPI FILE <br />/ <br />LAND USE FILE <br />DATE <br />OTHER AGENCY REPORT <br />EMERGENCY RESPONSE <br />Y / N <br />LEAD AGNCY/UNIT <br />V Ate. i �L l.�_ , I, u l'9 C <br />�"� �� 7 V U U 7 <br />SOIL CONT <br />SJ/EH <br />CONTACT <br />G /�-� <br />OW CONT <br />DHS CONTACT <br />ETROLEUM <br />- <br />- <br />#1 <br />/ <br />OTHER CONTACT <br />CITY <br />RWVCS <br />CONTACT <br />#4 <br />STATE <br />WOR <br />issued <br />Y / N <br />NPOES <br />issued <br />Y <br />/ <br />N <br />FAILED PT <br />V Ate. i �L l.�_ , I, u l'9 C <br />�"� �� 7 V U U 7 <br />SOIL CONT <br />—Z <br />/ <br />GW CONT <br />G /�-� <br />OW CONT <br />- <br />ETROLEUM <br />Y / N <br />SUBSTANCE <br />#1 <br />/ <br />#2 <br />CITY <br />#3 <br />STATE <br />#4 <br />STATE <br />#5 <br />PRIOR FAILED PT <br />NO ACTION <br />CLEAN UP COMPLETE <br />DATE <br />ENFORCEMENT ACTION <br />Y / N <br />ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br />SITE NAME <br />V Ate. i �L l.�_ , I, u l'9 C <br />�"� �� 7 V U U 7 <br />ADDRESS <br />. <br />CITY <br />G /�-� <br />STATE._- <br />- <br />ZIP <br />G!a <br />CONTACT NAME']- <br />l ♦M <br />PHONE <br />-1 <br />PROPERTY OWNER <br />COMPANY NAME <br />^ <br />O % <br />PHONE <br />PHONE <br />CONTACT NAME <br />CONTACT NAME <br />- <br />5 C <br />PHONE <br />ADDRESS <br />-1 <br />CITY <br />CITY <br />STATE <br />15-t k i <br />STATE <br />IP <br />RESPONSIBLE PARTY (If different from Property Owner) <br />COMPANY NAME <br />) <br />I, _ p n <br />N <br />PHONE <br />CONTACT NAME <br />PHONE <br />ADDRESS <br />CITY <br />STATE <br />ZIP <br />CONSULTANT PHONE <br />UAR # I ) - L/7 <br />I S/ _ DATE % Cx'-ll PROP 65 # '/ DATE / _7�(??/�/ PRIORITY <br />STREET # / `/ SITE STREET G2S� �-V e� . V �L/. APN # <br />9s 4oG <br />EH 23 070 (7/89)REVISED 03/91 89-19(IV) I :R2 <br />