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�.f T �,PIHSiS.�JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI'b,—. r� / <br /> `'�"l CONTAMINATED SITE D-Base MFR - INPUT FORM 1,6 p"7 — �i —fU , <br /> UPDATE: BY: REVIEWED BY: DATE ENTERED: / ' / L BY: <br /> SWEEPS/SITE CODE �/�� PROGRAM/ELEMENT ;� COMP # LOC CODE / DIST # Z3 <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O Q FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT Ri�11 SJ/EH CONTACT /�/ DHS CONTACT -- <br /> OTHER CONTACT RWQCB CONTACT /Y WDR issued FY <br /> / N NPDES issued Y / N <br /> FAILED P7 SOIL CONT GW CONT 6'•/[r 9/ OW CONT ETROLEUM G/ N <br /> SUBSTANCE #1 �0 v /17 #2 #3 7 94 #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: <br /> SITE NAME <br /> ADDRESS 222 A'• �V�/ /T!�/� C7��0 c <br /> CITY •l��/✓ ` d STATE C/4 ZIP <br /> CONTACT NAME G lel' PHONE 204 �'!f� --;W3 <br /> PROPERTY OWNER `- <br /> COMPANY NAME �G �. ci��Y'✓L�CT PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS �0 67. <br /> CITY 57'-0cle STATE ZIP 9CZ0 Z <br /> �}. RESPONSIBLE PARTY (If different from Property Owner) <br /> CCOMPANY NAME PHONE <br /> CONTACT NAME �. �/� PHONE 7i 2' V-/V <br /> ADDRESS , 8 ISDN /� �• /,D- ! / (QO <br /> CITY STATE ZIP q2 713 Jf ff <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # �a-� DATE �sr P� PRIORITY <br /> STREET # 2LZ SITE STREET ! z- APN # /,{4„ /Ov /4, Z <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 c� / <br />