Laserfiche WebLink
PHS/ JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI'r <br /> 3-9;L- CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / 17 //Z BY: REVIEWED BY: DATE ENTERED: O6 / --7,7/ BY <br /> SWEEPS/SITE CODE cel 9 PROGRAM/ELEMENT ! COMP # O 6 LOCO CODE- DIST # 3 <br /> UGi FILE PILOT FILE H W FILE SITE!M TIGATION /PWS FILE PRIV WELL FILE :EiES <br /> SOLID WASTE H2O 0 FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT � 5/ � SJ/EH CONTACT �/�I�L(f/�/�j¢ DHS CONTACT - <br /> OTHER CONTACT / FRWQCS CONTACT WDR issued Y / NPDES issued Y /Q <br /> FAILED PT SOIL CONT ?) _ GW CONT OW CONT ETROLEUM / N <br /> SUBSTANCE #1 ��� 3 #2 #3 #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 T <br /> ADDRESS o2 3 g 3 <br /> CITY STATE ZIP '7 <br /> CONTACT NAME PHONE < o <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME / _0 PHONE �y <br /> CONTACT NAME �A !73� PHONE (�l�C [ 2- <br /> ADDRESS ADDRESS <br /> CITY ( STATE ZIP <br /> CONSULTANT r PHONE <br /> UAR # LC� / DATE �( PROP 65 # 9�(L DATE _ - PRIORITY Q <br /> STREET # 2�3g3 SITE STREET � APN # 2 <br /> Q <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 (u <br />