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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE 7 BY REVIEWED BY. DATE ENTERED �J BY <br /> D^ ADDITION: EDIT.: <br /> SWFFPq SITE CODE 4� 9 COMP # LDC CSE DIST # <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATIONPWS FILE PRIV WELL FILE ENV ASSESS fI <br /> SOLID WASTE H2O 0 FILE EPI'FILE LAND USE FILE OTHER AGENCY REPORT H W SPILL/DISPOSAL <br /> PROGRAM/ELEMENT { LEAD AGENCY/UNIT SJ/EH CONTACT �� <br /> J <br /> RWOC$ CONTACT DHS CONTACT OTHER CONTACT <br /> FAILED PT SOIL CONT GW CONT DW CONT PETROLEUM Y / N <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 r PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONTACT NAME PHONE <br /> PROPERTY OWNER <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS l �� <br /> CITY l-yC�l_ STATE ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY r,►+ +t STATE ZIP 2 <br /> CONSULTANT y� l --l-b�Yyy� n PHONE <br /> ll!✓✓✓ .. �� 1 � � W i cl 1 <br /> UAR # DATE PROP 65 # DATE PRIORITY <br /> STREET # p O SITE STREET APN # <br /> o ` <br /> EH 23 070 (7/89)REVISED 11/90 89;19(IV) CNTMFR2 <br />