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' 0 <br />PIIS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br />Y,& <br />pp CONTAMINATED SITE D -Base MFR - INPUT FORM <br />% <br />UPDATE: / 1 / BY: Y,& REVIEWED BY: DATE ENTERED: / / BY:'291 <br />�- <br />LEAD AGNCY/UNIT <br />; R hj <br />SJ/EH CONTACT <br />LOC CODE <br />DIST # <br />/`��/ <br />SWEEPS/SITE CODE a I <br />PROGRAM/ELEMENT COMP T <br />UGT FILE <br />X PILOT FILE <br />WOR issued <br />H W FILE SITE MITIGATION <br />NPDES isscr, / N <br />PUS FILE <br />ZIP <br />PRIV WELL FILE <br />ENV ASSESS <br />- <br />SOLID WASTE <br />I <br />H2O 0 FILE <br />EP[ FILE <br />LAND USE FILE <br />CLEAN UP COMPLETE <br />OTHER AGENCY REPORT <br />DATE <br />EMERGENCY RESPONSE <br />ENFORCEMENT ACTION <br />LEAD AGNCY/UNIT <br />; R hj <br />SJ/EH CONTACT <br />, <br />DHS CONTACT <br />/`��/ <br />OTHER CONTACT <br />PRIORITY <br />RWOCB CONTACT <br />Y / N <br />WOR issued <br />Y / N <br />NPDES isscr, / N <br />FAILED PTSOIL <br />; R hj <br />CONT <br />7- <br />CONT <br />/`��/ <br />OW CONT <br />PRIORITY <br />ETROLEUM <br />Y / N <br />SUBSTANCE <br />#1 <br />#2 <br />[c1q <br />ZIP <br />93 <br />- <br />PRIOR FAILED PT <br />NO ACTION <br />CLEAN UP COMPLETE <br />DATE <br />ENFORCEMENT ACTION <br />Y / N <br />r -n PnRCFMFNT TYPF: Al� 2 3 4 5 6 DATE ACTION TAKEN: / / <br />SITE NAME <br />; R hj <br />ADDRESS <br />PROP 65 # <br />CITY <br />/`��/ <br />STATE <br />PRIORITY <br />ZIP <br />f %. , <br />/ <br />CONTACT NA14E <br />PHONE <br />[c1q <br />V <br />DRnPFRTY CMNFR <br />COMPANY NAME <br />; R hj <br />PHONE <br />PROP 65 # <br />CONTACT NAME <br />ci <br />PHONE <br />PRIORITY <br />ADDRESS <br />f %. , <br />/ <br />CITY <br />sfo c-, <br />STATE <br />[c1q <br />ZIP <br />RESPONSIBLE PARTY (if different from Property Owner) <br />COMPANY NAME <br />G(�y ��ZQ�'L/ <br />PHONE <br />PROP 65 # <br />CONTACT NAME <br />DATE <br />PHONE <br />PRIORITY <br />ADDRESS <br />STREET # <br />CITY <br />SITE STREET <br />STATE <br />APN # <br />ZIP <br />CONSULTANT <br />�i�j %/?� DATE <br />PHONE <br />PROP 65 # <br />UAR # <br />�i�j %/?� DATE <br />�� ' gl <br />PROP 65 # <br />��j //f <br />DATE <br />�� <br />PRIORITY <br />STREET # <br />f l <br />SITE STREET <br />`f (�( <br />APN # <br />EH 23 070 (7/89)" 89-19(IV) CNTMFR2 REVISED 12/94 <br />