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<br />OHS CONTACT <br /> <br /> of <br /> <br />voR issued Y / N NPDES / N <br />PHS/.. JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIM. <br />CONTAMINATED SITE 0-Base MFR - INPUT FORM <br />UPDATE: ' / S'/ BY: REVIEWED BY: DATE ENTERED: //73 / , q? <br />. .... <br />01ST 4 <br />SWEEPS/SITE CODE ..j*L36) 1-/- PROGRAM/ELEMENT <br />.--- , --,-, <br />OMP d LOC CODE <br />UGT FILE X PILOT FILE H W FILE SI MITIGATION PUS FILE 1 PRIV WELL FILE ENV ASSESS <br />SOLID WASTE H20 Q FILE EPI FILE LAND USE FILE OTHER AGENCY REPORT EMERGENCY RESPrI4SE <br />SJ/EH CONTACTc LEAD AGNCY/UNIT <br />OTHER CONTACT +• , <br />I ft CC Pi <br />RWOCB CONTACT <br />FAILED PT SOIL CONT /0-16- 5'17 GW CONT IOW CONT PETROLEUM Y / N <br />SUESTANCE 41 Le-,=C-e--L-- <br />42 <br />PRIOR FAILED PT NO ACTION CLEAN UP COMPLETE DATE ENFORCEMENT ACTION Y / N <br />ENFORCEMENT TYPE: 2 3 4 5 6 DATE ACTION TAKEN: I / AK / / <br />,-- <br />SITE NAME <br />R i 12-0-C2 C.It- (- erl'o / cf Lbl-v_, (°,,v„, d!6) (:, k_ <br />ADDRESS <br />CITY STATE STATE (.:/q" ZIP <br />CONTACT NAME 0 cz-tLe___ ±ct_c_f\--_6--)_-_-2 PHONE c,746F7-3--?3:), <br />PROPERTY OWNER <br />COMPANY NAME t , mt-1-6-<(_, ---iii_r_6... a PHCNE <br />CONTACT NAME <br /> LS kdd }N..) _Li )1(1-a-/Ku' <br />PHONE / 0 90 qq. <br />ADDRESS <br /> (7N 1 \ IV, Lt9t. I <br />CITY S-1--o c r STATE (14 ZIP q5;co <br />RESPONSIBLE PARTY (If different from Property Owner) <br />COMPANY NAME PHONE <br />CONTACT NAME PHONE <br />ADDRESS <br />CITY 1 STATE ZIP <br /> <br />PHONE 1 <br /> <br />CONSULTANT <br /> <br />UAR 4 DATE i0...,R '--- 7 PROP 65 4 DATE JO-) -‘-'1' PRIORITY <br />STREET 4 ..,a 1 ( SITE STREET LO f i ...S-2..6":7 APN <br />-5"(A) - 7 <br />»- <br />-,1 i 1-1-73--76--- <br />REVISED 12/94 89-19(IV) CNTMFR2 EH 23 070 (7/89)"