Laserfiche WebLink
PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE D-Base MFR - INPUT FORM <br /> UPDATE: /�'� / I BY: REVIEWED BY: DATE ENTERED: / Q/ lj By; <br /> SWEEPS/SITE CODE y�clr�9 PROGRAM/ELEMENT �7 / c-,) COMP # LOC CODE <f�/� DIST # ?j 2 V <br /> UGT FILE PILOT FILE H W FILEIx SITE MITIGATION PWS FILE PRIV WELL FILE ENV ASSESS <br /> SOLID WASTE H2O Q FILE EP[ FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> LEAD AGNCY/UNIT ( ( P - � SJ/EH CONTACT l l'� DHS CONTACT - <br /> q <br /> OTHER CONTACT RWOCB CONTACT11 WOR issued Y <br /> �O l l L�.��� / � NPDES issuTedY <br /> FAILED PT SOIL CONT 2 _ Z7- f GW CONT DW CONT IP <br /> ETROLEUM Y / <br /> SUBSTANCE #1 / v J Z� #2 1(070C,� <br /> #3 � #42cr #5 10%-6PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE 1/y <br /> DATE ENFORCEMENT ACTION Y /� I <br /> ENFORCEMENT TYPE: 1 2 3 4 5 6 DATE ACJION TAKEN: <br /> SITE NAME ) <br /> �Gr/^t'i? <br /> ADDRESS - <br /> CITY TsTATEZIP <br /> CONTACT NAME age PHONE �//s l L}30- (x-23/ <br /> PROPERTY OWNER / J <br /> COMPANY NAME ^ PHONE <br /> S er v r Wl mei✓J�-- 1rl.e . <br /> CONTACT NAME e \ PHONE <br /> ADDRESS <br /> CITY ce Svic) STATE C� ZIP <br /> RESPONSIBLE PARTY (If different from Property Owner) J <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT 1 � Sv ` f PHONE U/ <br /> UAR # DATE PROP 65 # DATE ;'%�Z / PRIORITY <br /> STREET # 35��v SITE STREET L(� 6 APN # ZSS <br /> EH 23 070 (7/89)REVISED 03/91 89-19(IV) CNTMFR2 <br />