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SAN, JOAQUI•N•LOCAL .HrAtTH. DISTRICT , '. <br /> CONTAMINATED SITE 'MFR - INPUT FORM " <br /> UPDATE / /e-( BY DATE ENTERED �/ / G/ BY <br /> ADDITION: ✓ EDIT: DELETE: <br /> SWEEPS # In COMPUTER # GU DIST IAC CODE 0� <br /> UGT FILE W FILE I LAND USE FILE PWS FILE PILOT PROG <br /> FAILED PT I SOIL CONT / � / GW CONT I DW CONT <br /> PETROLEUM Y / N PILOT I Y / N ENTERED PILOT <br /> SITE NAME r <br /> ADDRESS PHONE-` <br /> CITY S72J ISTATE CA ZIP 9c) 3 <br /> CONTACT NAME CROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE <br /> MAILING/STREET ADDRESS Jr �} 52-oc40�j <br /> CITY I <br /> V76N I <br /> STATE <br /> CONTACT NAME b,4U /[) GJ47Q QIAjC� PHONE <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> CONTACT NAME PHONE <br /> COMPANY NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> SJLHD CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR I Y / N UAR / / PROP 65 / N /a / PRIORITY <br /> SITE STREET fi STREET It <br /> EH N 50 (5/89) Q�j 88-017 (IV) REVISED 5/89 CNTMFR <br />