Laserfiche WebLink
PHS0- 1 JOAQUIN COUNTY - EN`JIRONMENTAL HEALTH DIVION <br /> CONTAMINATED SITE D-Base MFR INPUT FORM <br /> UPDATE: l / ( / BY: S REVIEWED BY: DATE ENTERED: JA 2S l99`j BY: <br /> SWEEPS/SITE CODE 1157�— PROGRAM/ELEMENT ZCJ�) COMP # LOC CODE J D1 #T-TZZ--- <br /> UGT <br /> FILE PILOT FILE H W FILE SITE MITIGATION PUS FILE PRIV WELL FILE/ ENV ASSESS <br /> SOLID WASTE 1120 Q FILE EPI FILET I LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT // SJ/EH CONTACT N DHS CONTACT <br /> OTHER CONTACT UUU RWQCB CONTACT UDR issued LY <br /> / N NPDES issued Y 6 <br /> FAILED PT SOIL CONT 2O/�( 1 GW CONT DW CONT ETROLEUM / N <br /> SUBSTANCE #1 #2 ✓ UUU / #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 <br /> ADDRESS <br /> CITY � O ,�/1 STATE � ZIP <br /> CONTACT NAME T/' / PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME �f / PHONE <br /> CONTACT NAME l�fD� PHONE <br /> ADDRESS /00 <br /> CITY l(J�GC� 11m U� STATE m� ZIP 1,"—/ zo — <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME2nzz� /' ) , PHONE 1 S 3 <br /> CONTACT NAME 42,& <br /> _ /�_ PHONE <br /> ADDRESS y� _ <br /> CITY 77 v STATE / ZIP 9�� <br /> CONSULTANT PHONE <br /> UAR # DATE PROP 65 # [DATE PRIORITY <br /> STREET # SITE STRE T APN # <br /> 77 <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />