Laserfiche WebLink
PHS/SAl;ACUIN COUNTY - ENVIRONMENTAL HEALTH DIVISI <br /> CONTAMINATED SITE O-Base MFR - INPUT FORM <br /> UPDATE: ?j I / ZBY REVIEWED $Y: DATE ENTERED. 3 BY: <br /> SWEEPS/SITE 000E✓EPROGRAM/EL JMEYT CCMP # LOC=ccoEz?-' DIST .Y 3.7 <br /> UGT FILE L)XPILOT FILE H W FILE 1 SITE MITIGATION PWS FILE PRIV WELL-FILZ ENV ASSESS <br /> SOLID WASiE 1120 0 FILE LEPIILE LAND USE FILE OTHER AGENCY REI ORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT S1/EH CONTACT OH5 CCNTACT <br /> OTHER CONTACT RWOCB CCNTACT F WOR issued Y / N NPOES .issued Y / N <br /> FAILED PT SOIL CONTl Z 1 "47 <br /> Gu CONT Du CONT ETROLEUM Y / N <br /> SUBSTANCE #1 /7-0 3;Z-1 »2 "3 "4 #5 <br /> PRIOR FAILED PT NO ACTICN CLEAN UP CCMPLETEL I <br /> DATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 G 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADORESS <br /> r <br /> CITY /7 � STATE ZIP <br /> M /7 PHONE <br /> CCNTACT NAME c� <br /> PRCPERTY OWNER <br /> COMPANY NAME , w] �jc� e 6"p- PHONE <br /> N <br /> CCNTACT NAME PHONE 61k, <br /> ADDRESS /' `i/A&- <br /> II <br /> CITY Oe-R STATE �• ,, <br /> ZIP <br /> RESPONSIBLE PARTY (if different from Property Ourer) ��T' <br /> CCMPANY NAME <br /> M f�`,�. l PHONE <br /> CCNTACT NAME C� d� PHONE <br /> ADDRESS <br /> r. <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR Y �� DATE �%� PROP 65 # Z��S DATE ,zr�/^`e/ PRIORITY <br /> STREET # SITE STREET GiL l � APN # <br /> EN 23 070 (7/89)REVISED 03/97 89-19(IV) CNTMFR2 V 1 <br />