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`�¢y� PHS/SACUIN COUNTY - ENVIRONMENTAL HEALTH 0[VIS <br /> ,P10�-5e a-14a C CONTAMINATED SITE D-Base MFR • INPUT FORM <br /> co <br /> �f <br /> UPDATE: ! / Z /?I BY: REVIEWED BY: DATE 'ENTERED: -�t � gY� <br /> SWEEPS/SITE CODE 41 �7 PROGRAM/ELEMENT 23. I COMP ' I U�`L y 8o I LOC CCDE I 01 JOIST 323 <br /> UGT FILE PILOT FILE H U FILE SITE MITIGATION PUS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILE EPI FILE LANG USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT ONS CONTACT -' <br /> OTHER CONTACT RS.00S CONTACT UDR issued Y / N NPOES issued Y / N <br /> FAILED PT SOIL CONT l(�/'�Z/�d GW CONT DW CONT IPETROLEUM cy / <br /> N <br /> $UB$TANCE -1 <br /> 2 03 z #2 13 u5 <br /> PRIOR FAILED PT INO ACTION A <br /> CLEAN UP COMPLETE TOATE ENFORCEMENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME I VOL al <br /> ADDRESS tylato <br /> CITY 4t I-) I STATE CA 21P ,0Z ( -'- <br /> CONTACT NAME d 1/ //y�Ul<� PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME <br /> kqI ld r1 K� PHONE <br /> CONTACT NAME PHONE 1 <br /> ADDRESS 8 oX Z 3 <br /> $TATE cl�I/f <br /> 2[P <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATEF- ZIP <br /> PHONE <br /> CCNSJLTANT <br /> UAR DATE !o/ZS�90 PRCP 65 190-;�301 DATE I <br /> STREET A 1900 I SITE STREET rn�l APN <br /> EH 23 070 (7/89))REVISED 03/91 89-19(IV) C.VTMFR2 <br />