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PHS/5....,.OA(7UIH COUNTY - ENVIRONMENTAL HEALTH DIVISI -so, <br /> CONTAMINATED SITE D-Base MFR - INPUT FORA p <br /> UPDATE: 7 BY: r,'T- REVIEWED BY'. DATE ENTERED: -7 BY: .. <br /> STEEPS/SITE CODE I ,1 0U07 PROGRAM/ELEMENT 3. % C(riP $ LOC CODE -7 I DIST : IL <br /> LOT FILE PILOT FILE H V FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE ( OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> lE AGNCY/UNIT SJ/EH CONTACT/G,%��71�'/f�.� DHS CONTACT - - <br /> OTHER CC <br /> RWOCS CONTACT WVR issued Y / H NIPOES issued Y / N <br /> FAILED PT I SOIL CONT 'J�6 `T GW CORY 4OW CONT PETROLEUM Y / N <br /> SUBSTANCE .1 . ^2 93 I / P.4 �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: _/-I- <br /> SI <br /> I-- <br /> _/_/_SIT"c NAME <br /> ADDRESS 2G yU,,//,y� <br /> CITY // �/V /'� s7aiE ��/q ZIP <br /> CCN TACT Nu+E 7V�-�Fi'� / ♦��- _ PHONE <br /> PROPERTY OWNER <br /> PHONE <br /> PANT NAME <br /> CONTACT NAME /.�/�j� Gfj�7E� I PHONE <br /> ADDRESS <br /> CITY �� Lc-„ /2� STATE 21P I Gj� GCl` <br /> RESPONSIBLE PARTY (If different frau Property Owner) ( <br /> COMPANY NAME PHONE <br /> CONTACT NAME I PHONE <br /> ADDRESS <br /> CITY - STATE ZIP <br /> CONSULTANT PHONE <br /> UAR C (73 _UA, DATEE �ESTREET <br /> PROP 65 i [ .L / DATE STREET Y 2(�tSI ��T(]� �0j1J� APN <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />