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PHS/SAN JOAO V COUNTY — ENVIRONMENTAL ILTH DIVISION <br /> COWrAMINATED SITE MFR — INPUT`r0RM <br /> UPDATE jt, /_ / BY „ 'I REVIEWED BY p, DATE ENTERED BY °! <br /> ADDITION• EDIT• <br /> SWEEPS # b r COMPUTER # DIST # I LOC CODE <br /> GUTfL <br /> UST FILE H W FILE LAND USE FILE PWS FILE PILOT PROD <br /> FAILED PT U.��/N�wl SOIL CONT , / / GW CONT DW CONT <br /> PETROLEUM Y / N ENTERED PILOT / / GROG/ELEMENT 3. <br /> SITE NAME <br /> ADDRESS PHONE , <br /> 6 <br /> CITY STATE CA ZIP <br /> G�K�On� 7�� U <br /> CONTACT NAME Goff CROSS STREET <br /> PROPERTY OWNER <br /> NAME 7 PHONE <br /> �1 <br /> MAILING/STREET ADDRESS <br /> CITY STATE ZIF' <br /> CONTACT NAME PHONE <br /> RESPONSIBLE PARTY ( If different from Property Owner) <br /> COMPANY NAME PHONE <br /> I <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT F'HONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # 19,D —(),9D DATE I r -'51 / PROP 65 # �0 —a/S' DATE70 1 <br /> STREET # � SITE STREET <br /> <'k,iA/.v(, l PRIORITY <br /> EH 23 070 (7/89) 89-19 (IV) 7/89 CNTMFR <br />