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J _ <br /> PHS/SAN JOACP[N COUNTY - ENVIRONMENTAL II DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORIM <br /> UPDATE /Q'dy/�� By I I/C REVIEWED BY DATE ENTERED <br /> ADDITION:_ EDITc <br /> SWEEPS a as 07- 6 .r. COMPUTER a O 7DIST 3a, 3 LOC CODE <br /> k <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT FROG <br /> FAILED PT / / SOIL CONT 1D /alf /9� GW CONT / / DW CUNT <br /> PETROLEUM Y / N ENTERED PILOT / / PkOG/ELEMENT <br /> SITE NAME - .S <br /> ADDRESS D PHONE FF <br /> CITY STATE CR ZIP GJ Q <br /> CONTACT NAME �r-- <br /> !`�a'nk CROSS STREET D <br /> PROPERTY OWNER <br /> NAME s p <br /> rI G, PHONE �Q 9 610 -9SdQ <br /> MAILING/ETRE ADDRESS <br /> CITY STATE K <br /> � Cr ZIF' <br /> CONTACT NAME ? � <br /> PHONE <br /> RESPONSIBLE PARTY (If different Zfromrooc' <br /> rty Owner,) <br /> COMPANY NAME <br /> PHONE <br /> CONTACT NAME <br /> PHONE <br /> ADDRESS <br /> CITY <br /> STATE ZIP <br /> CONSULTANT <br /> PHONE <br /> SJ/EH CONTACT <br /> RWOCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UQR # - . DATE ID IFID PROP 65 # - DATE <br /> STREET N SITE STREET <br /> � PRIORITY <br /> EH 23 070 (7/89) 89-19 ( IV) 7/89 CNTMFR <br />