Laserfiche WebLink
PHS JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DTVI--.IN <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: L / 2 /9) BY: REVIEWED BY: DATE ENTERED: / /C/ BY: <br /> f T ,/ <br /> SWEEPS/SITE CODE �� -3E; PROGRAM/ELEMENT 2 3, g Q COMP # �aC P LOC CODE q DTST�#FZ <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PNS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O Q FILE EPI FILE LAND USE FILEF I OTHER AGENCY REPORTEMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT SJ/EH CONTACT DHS CONTACT — <br /> OTHER CONTACT RWQCB CONTACT L <br /> WDR issued Y / N NPDES issued Y / N <br /> FAILED PT SOIL CONT 1-2 -z'l II GW CONT DW CONT ETROLEUM �/ N <br /> SUBSTANCE 91 2��Z__ #2 #3 #4 #5 <br /> PRIOR FAILED PT N4 ACTION CLEAN UP COMPLETEDATE [ENFORCEMENT ACTION Y / N <br /> _ __[ <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME Jac <br /> �f O <br /> ADDRESS 1 �J N-- Pd . <br /> CITY LD f/} ,I STATE �' ZIP f L <br /> CONTACT NAME �/�J ,! ` 1�/ti PHONE 4 a�Yt� } C llJ/�I� " q U <br /> PROPERTY OWNER I iiJJ« I �/ t1 <br /> COMPANY NAME 11 I�l/l f� � PHONE �C�� �Q/ � C�j qt'// <br /> CONTACT NAME ` r �� PHONE (�J(�` T T <br /> ADDRESS <br /> CITY , STATE GU J4 ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CCNTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE Zip <br /> CONSULTANT PHONE <br /> [VAR # -�' [DATEPROP 65 # Cf��G� DAZE I !�/ PRIORITY <br /> tTREFT # ! �)q7, J SITE STREET VQL�R �7/�� APN # <br /> EH 23 070 (7/89)REVISED 703/91 89-19(IV) CNTMFR2 L <br />