Laserfiche WebLink
PHs/5•AWSN COUNTY • ENVIRONMENTAL HEALTH OIV1S A, <br /> CONTAMINATED SITE 0-Base MFR INPUT FORM <br /> � REVIEWED 3Y: - DATE ENTERED: 3Yt <br /> i_ 'G / a-S / � .3 <br /> UPOATE: / "/ 3Y: /7 /��j� <br /> 2ZJ.g0 /)0 /C/22 LGC CODE O/ DIS; : <br /> SUE:?S/SITE COO <br /> IZ�J P CGRAH/ELEMENT v CCNP x <br /> PILOT FILE H U FILE SITE MITIGATION <br /> PUS FILEc PR(V WELL FILE ENV ASSESS <br /> UGT FILE <br /> SOLID WASTE H2O O FILE EP[ FILE <br /> LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> SJ/EH CONTACT DHS CONTACT -- <br /> LEAD ACNCYNNIT <br /> RWC3 CCNTACT WAR issued Y / N HPOES issued Y / N <br /> OTHER CONTACT <br /> �// GU CONT OU CONT STROLEUM <br /> FAILED ?T SOIL CONI (� y C/ <br /> �/ <br /> 13 x5 <br /> SUBSTANCE x1 / 03?— <br /> 1!V GATE I 'ENFORCEMENT ACTION Y / N <br /> ?RICK FAILED PT NO ACTION CLEAN UP COMPLETE <br /> ENFORCEMENT TYPE: 1 2 33�4/� 5 6 DATE ACTION TAXEN: /� <br /> FACORESS <br /> NE /fn <br /> or / \d / �O/ STATE ' ZlP C�JL�//�Ui //11 ?HONE NAME <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE y ��6 �Z�� <br /> (/ �N �vv PHONE ��i '� <br /> CONTACT NAME Y / <br /> ADDRESS -00I VV W <br /> STATE ZIP <br /> RESPCNStSLE PARTY (if different }ran Property Owner) <br /> PHONE <br /> CMPANY NAME <br /> PHONE <br /> =MTACT NAME <br /> ADDRESS <br /> STATE ZIP <br /> CITY <br /> PHONE <br /> C^NSUL TANT <br /> UAR DATE <br /> i/ PRCP 65 x 9 7 DATE �� �3 PR1CRItt <br /> � 3-��.� � G .3 �Li <br /> 1� AVN x <br /> STREET ! I SITE SiREE7 Or./' P/),,/)( <br /> A9-19(m CITMFRZ <br />