Laserfiche WebLink
SJLHD CONTAMINATED SITE MFR FORM PACE 1 <br /> r NOTE: THIS FORM IS TO BE USED FOR ADDING, DELETING AND EDITING <br /> INFORMATION FOR THE CONTAMINATED SITES DATA BASE. ONLY THE <br /> SWEEPS NUMBER AND FACILITY NAME WILL BE REQUIRED TO IDENTIFY THE <br /> APPROPRIATE RECORD FOR EDITS AND DELETES . ALL APPROPRIATE <br /> INFORMATION SHOULD BE FILLEDOUTFOR ADDITIONS TO THE DATA BASE. <br /> UPDATE: 3 Z�/ SUBMITTED BY: �/f7 <initials> DATE ENTERED: <br /> ADDITION : V EDIT: —eL_ DELETE: <check one> <br /> ------------------------ <br /> SWEEPS q : /O�3 COMP# : GIF DISTN : � LOC <br /> CODE: C <br /> FACILITY NAME: ff/7 <br /> ��y F J�VG 7(i✓ C�9rs Ce <br /> FACILITY STREET: _ 5�35� S, (lF/wl%�,e JT <abbreviate> <br /> i <br /> FACILITY CITY: e�ee7L2/y FAC STATE: CA FAC ZIP : 52 5 <br /> FACILITY TEL : 209 FACILITY CONTACT: /`7���C� <br /> OWNER NAME": _PG CeM�_ <br /> OWNER STREET: rl, �/� Gl�ST <br /> OWNER CITY :' JTG`�7�✓��yyOWNER STATE: 4 i4 OWNER ZIP: <br /> Z� l7b <br /> OWNER TEL: OddpWNER CONTACT: �/1C-� [J�Ni✓ET� <br /> l <br /> UGST FILE: H.H. FILE: _ LAND FILE: _ WATER FILE: <br /> FAILED PT: SOIL CONTAMINATION: ✓ CUBIC YDS : <br /> GROUND WATER CONT: _ SURFACE WATER CONTAMINATION: <br /> DRINKING WATER CONT: _ OTHER CONT: _ <T or F> <br /> TPH: -Z BEN: TOL: XYL: _ ETHYL BEN: EDB: _ <br /> SOLVENTS : AROMATICS : METALS : _ OTHER : <T or F> <br /> i <br /> EH 23 070 ( 2 ) 2/88 <br />