Laserfiche WebLink
PHs;W JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DTVI` W <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / �� BY: REVIEWED BY: DATE ENTERED: / /9� BY: <br /> SWEEPS it SITE CODE � COMP # � � � LOC CODE DIST # ZZi <br /> UGT FILE iPILOT FILE H W FILE SITE MITIGATION PWS FILE PRIV WELL FILEENV ASSESS <br /> SOLID WASTE H2O G FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT I IH W SPILL/DISPOSAL <br /> PROGRAM/ELEMENT ll,5-1 LEAD AGENCY/UNIT pu` SJ/EH CONTACT <br /> RWQCB CONTACT / .u� DHS CONTACT 70THER CONTACT <br /> FAILED PT SOIL CONT Ll� /,D/7-.,ZA GW CONT DW CONT PETROLEUM Y / N <br /> SUBSTANCE #1 lz,* #2 #3 1 #4 #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 PHONE <br /> 1 �e- <br /> ADDRESS V6 q6 <br /> S� DDS, STATE C� ZIP <br /> CITY �� S✓ <br /> CONTACT NAME , PHONE —SZtLL( <br /> PROPERTY OWNER <br /> COMPANY NAME /� PHONE <br /> CONTACT NAME / PHONE <br /> ADDRESS <br /> CITY STATE CA IzIP14? 37� O <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE Z a y <br /> UAR # 1 PROP 65 # TqTf DATE zlql PRIORITY <br /> STREET # �6U SITE STREET /�, / / �-._ n _ APN # /r� -02-c)O <br /> EH 23 070 (7/89)REVISED 01/91 89-19(IV) CNTMFR2 <br />