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PIAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DI ON <br /> ` CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: g/ ,3 /9 SY: REVIEWED BY: DATE ENTERED: 1i7 / l / BY: <br /> r I <br /> SWEEPS/SITE CODE Q a PROGRAM/ELEMENT d13. $O COMP # 0AA0 LOC CODE 0 r [DIST <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLfO WASTE H2O Q FILE EPI FILE FANO USE FILE OTHER AGENCY REPORT EMERG"cNGY RESPONSE <br /> 4 <br /> LEAD AGNEY/UNIT -P � /1 SJ/EH CONTACT DHS CONTACT -- <br /> OTHER CONTACT - µj- [RWOCB CONTACT WDR issued Y / H HPDES issued Y / N <br /> FAILED PT SOIL CONT ..r�-. ' GW CONT DW CONT ETROLEUM Y / N <br /> SUBSTANCE #7 ` D3 #2 #3 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / :N:: <br /> ENFORCEMENT TYPE: 0 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME { <br /> i <br /> ADDRESS c + j` <br /> CITY �y�j / STATE C ZIP <br /> CONTACT NAME Com!! ll ► v . �, PHONE <br /> PROPERTY OWNER l <br /> COMPANY NAM PHONE <br /> CONTACT NAME + Ur\ � (L)A `i} PHONE 0 CL <br /> C�Qq) Y63-Sa <br /> ADDRESSr I 7 <br /> CITY STATE /Q Zip g 5 a or(.C-1 K�1� I <br /> RESPONSIBLE PARTY (If different from Property Owner) ✓ <br /> r <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS ' <br /> CITY STATE ZIP <br /> CONSULTANT PHONE ' <br /> UAR # 1q)-4vi" DATE , 1y ! PROP 65 # _ DATE `3���'�' PRIORITY <br /> STREET # O Q 7 SITE STREET j I " F APN # <br /> EH 23 C70 (7/89)REVISED 03/97 89-79(IV) CNTMFR2`" - ' <br />