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SJLHD CONTAMINATED SITE MFR FORM PAGE 1 <br /> C <br /> NOTE: THIS FORM IS TO BE USED FOR ADDING, DELETING AND EDITING 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 DE FILLED OUT FOR ADDITIONS TO THE DATA BASE. <br /> UPDATE: SUBMITTED BY: i-c <Initials> DATE ENTERED: <br /> ADDITION : EDIT: DELETE: <br /> <check one> <br /> SWEEPS Y : IJ COMPY : Ce6hr7r , jDISTY : C <br /> LOC CODE: <br /> FACILITY NAME:j�IDy(� X24 <br /> FACILITY S rr,_,.,r, 63& <br /> FACILITY CITY: J FAC STATE: CA FAC ZIP: <br /> FACILITY TEL : 209 /�/� FACILITY CONTACT: <br /> ` OWNER NAME. <br /> j OWNER STREET: <br /> OWNER CITY:) <br /> OWNER STATE: , OWNER ZIP: �Oo�et <br /> OWNER TEL : <br /> ' �! OWNER CONTACT: <br /> / <br /> ll UGST FILE: V H.W. FILE: LAND FILE: %/ <br /> HATER FILE: <br /> FAILED PT: SOIL CONTAMINATION; <br /> CUBIC YDS : <br /> GROUND HATER CONT: SURFACE WATER CONTAMINATION: _ <br /> DRINKING WATER CONT: <br /> OTHER CONT: <T or F> <br /> TPH: BEN: TOL: <br /> XYL: __ ETHYL HEN: <br /> EDD: _ <br /> SOLVENTS : AROMATICS: <br /> METALS: OTHER : <T or F> <br /> t <br /> EH 23 070 ( 2 ) 2/88 <br />