Laserfiche WebLink
PNS/&OACUIN COUNTY ENVIRONMENTAL HEALTH DIVISI� <br /> CONTAMINATED SITE 0-3ase MFR INPUT FORM <br /> UPDATE: /l_1 / 3 3Y: l'j ,/� REVIE41E0 BY: V`) DATE ENTERED: /3J /y 3 3Y: <br /> iuE EPS/SITE COO E D�'g CGRAM/ELEMENT COMP d LOC CODE I DIST <br /> UGT FILE PILOT FILE N V FILE I SITE MITIGATION PVS PILE PRIV WELL FILE ENV ASSESS <br /> SOLID 'JASTE H2O O FILE 'EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSEE <br /> LEAD AGNCYNNIT c ��Q�,2 SJ/EH CCNTACT OHS CONTACT -- <br /> OTHER CCNTACT 1. lU RNOC3 CONTACT WOR issued Y / N NPOES issued Y / N <br /> FAILED PT SOIL CONT U_G GW CCNT OW CONT ETROLEUM 10/ m <br /> SUBSTANCE I xl —76 02 1 ( -,3 :5 <br /> PR(CR 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 /C� <br /> CJS 00L„9t� J llex.J L.O 4 <br /> AcoaEss �(� ( I✓ rOc G1vc�c' SCC �14L' <br /> v of <br /> CITY �� STATE I C9 ZIP <br /> //11 �r c,c 1 //_ y.� <br /> CONTACT NAME I C\� _V COD,., l Kt. L�4' I'Yt !1 PHONE $j0 <br /> PRCPERTY OWNER Nc t7 <br /> CCMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> C <br /> RESPONSISLE PARTY (If different from Property Omer) <br /> CMPANY NAME PHONE <br /> e.0 f o <br /> CONTACT NAME ; lC� /�c,r r t PHONE <br /> ADDRESS e23(�CJ (9C�'�✓L-4.� 1� <br /> CITY STATE /) ZIP 56 <br /> C--NSULTANT l- PHCNE J <br /> UAR 1 -- DATE �- PROP 65 d /•. DATE Y3 PRIORITY <br /> STREET Y Op SITE STREET v0�Lc1 APR 2 <br />