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1 <br /> t <br /> PIIS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: / / BY: REVIEWED BY. DATE ENTERED: / / BY: <br /> SWEEPS/SITE CODE , j--1Z PROGRAM/ELEMENT COMP # lOC CODE j DIST # 3 Z Z`j <br /> UGT FILE PILOT FILE H W FILE SITE MITIGATION PUS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE HZO G FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT ` SJ/EH CONTACT /�'Q� DHS CONTACT <br /> OTHER CONTACT RWDCB CONTACT WDR issued Y / N NPDES issue 1 / N <br /> FAILED PT SOIL CONT '7 lZvlf�- I <br /> GW CONT DW CONT ETROLEUM Y / N <br /> SUBSTANCE #1 #2 fo O lQ E'` 93 #4 #5 <br /> PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTtON <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACTION TAKEN: <br /> SITE NAME <br /> ADDRESS <br /> CITY t _7" STATE 1 ZIP <br /> CONTACT NA14E T'� < � PHONE \2-- CO 2j3t�•�j'Z?j <br /> PROPERTY OWNER <br /> COMPANY NAME �wPHONE <br /> CONTACT NAME � .� C � PHONE <br /> ADDRESS li!/• -�i Mel- <br /> CITY <br /> STATE ZIP L <br /> RESPONSIBLE PARTY (if different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> UAR # DATE 7/Zp� PROP 65 # DATE ��Z� PRIORITY <br /> STREET # 1 ,13ol SITE STREET r_ APN # <br /> cu '311 n7n r7rfi0)' A9-19(IV) CNTMFR2 REVISED 12/94 <br />