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PHS/SAN JC UIN COUNTY — ENVIRONMENTA HEALTH DIVISION <br /> L`DNTAMINATED SITE MFR — INF'UI FORM <br /> ' UPDATE t�f /7,7/8 BYLe <br /> REVIEWED BY DATE ENTERED 51 / BY <br /> A DITION: EDIT• <br /> SWEEPS # / ��6 COMPUTER # 3 DIST # 2� LOC CODE el-3 <br /> UGT FILE H W FILE LAND USE FILE PWS FILE/ F'ILOT PRGG <br /> FAILED PT J� /-77 152 SOIL CONT / / GW CONT / / DW CONT <br /> PETROLEUM 6yN ENTERED PILOT / / FROG/ELEPtENT <br /> SITE NAME -2� <br /> r- <br /> ADDRESS 7 L�l�i PHONE ;?if P 3 9 I <br /> CITY STATE CA ZIP <br /> CONTACT NAME SCIS CROSS STREET PPri�2 <br /> PROPERTY OWNER <br /> NAME / G PHONE <br /> MAILING/STREET ADDRESS 4 S, pG 1'0 <br /> CITY �� STATE � ZIF' / 537 <br /> CONTACT NAME -/90 S O^J PHONE <br /> RESPONSIBLE PARTY ( If different from Property Owner) <br /> COMPANY NAME Ste( S PHONE <br /> I <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIF' <br /> CONSULTANT F'HONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> ` OTHER CONTACT <br /> UAR # '` — DATE S PROP 65 # —a yS DATE <br /> STREET # ©/ SITE STREET PRIORITY <br /> EH 23 070 (7/89) 89-19 ( IV) 7/89 CNTMFR <br />