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SJLHD CONTAMINATED SITE MFR FORM PAGE 1 <br /> 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 FIL[[[LEED OUT FOR ADDITIONS TO THE DATA BASE. <br /> UPDATE: 02 /D SUBMITTED BY : < initials> DATE ENTERED: <br /> ADDITION : EDIT: DELETE : <check one> <br /> SWEEPS q : C 0 M P N GTL/U DISTNLOC CODE: 03 <br /> FACILITY NAME: <br /> , <br /> FACILITY STREET: -��� 7`/ W �/ ` VAO <abbreviatee> <br /> FACILITY CITY: I2&y FAC STATE: CA FAC ZIP: -- �.3p, <br /> FACILITY TEL : 209 / 72 - FAC ILITY CONTACT: �rl� s4*0(/i/�Ij/ <br /> OWNER NAME: <br /> �� d.4l�/ &;e 40// �Uaw <br /> OWNER STREET: /1� �c /67/ <br /> OWNER CITY: 7�/OiPE�S OWNER STATE: ( OWNER ZIP: <br /> OWNER TEL : �/ 72 OWNER CONTACT: <br /> ii <br /> UGST FILE: ✓ H.W. 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 : _ BEN: ZTOL: XYL: _ ETHYL BEN: EDB: <br /> SOLVENTS : _ AROMATICS : METALS : OTHER : <T or F> <br /> EH N 50 ( 1 of 2 ) <br /> 2/88 REVISED <br /> ,::oma., •, .. _...:. . . .��xr.-•---..,..�...,.•—•-..-.....-.....-.___.. ... _.. . <br />