Laserfiche WebLink
0 <br /> PIIS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV [ON <br /> CONTAMINATED SITE D-Base MFR INPUT FORM <br /> J A <br /> UPDATE: / /b /C� BY: Mf REVIEWED BY: DATE ENTERED: U/ (�1 BY: <br /> SWEEPS/SITE CODEiC PROGRAM/ELEMENT COMP # LOC CODE Dill/ DIST 3 Z Z <br /> UGT FILE ✓ PILOT FILE TEPI <br /> E TSITE MITIGATION PUS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O 0 FILEFILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT / Seri <br /> I DHS CONTACT <br /> OTHER CONTACT RWQCB CONTACT �v " UDR issued Y / N NPDES issued Y /� <br /> FAILED PT SOIL CONT c (- 3 9 GW CONT DW CONT ETROLEUM c/ N <br /> SUBSTANCE #1 #2 #3 #4 #5 <br /> PRIOR FAILED PTNO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br /> EIIFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS <br /> CITY L• STATE 0,&J- ZIP 9� <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER ✓� <br /> COMPANY NAME /GN>K!✓ PHONE <br /> CONTACT NAME /J PHONE <br /> ADDRESS // Q 0309 <br /> CITY / J / STATE 2IP .�{ Xz32 , <br /> RESPONSIBLE PARTY (I different from Property Owner) ✓ L�JS� <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY "STATE ZiP <br /> CONSULTANT NE <br /> L-17 1 <br /> UAR # DATE /j PROP b # DATE p PRIORITY <br /> STREET # h SITE STREET APN # <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />