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Sm,%.,OAQUIN LOCAL HEALTH DISTR✓P <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE 7/2� / �� BY 1 DATE ENTERED BY <br /> ADDITION: EDIT: DELETE: <br /> SWEEPS # /j COMPUTER # JCGU2IZ DIST # 1 �12LOC CODE <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT PROG <br /> FAILED PT / / SOIL CONT 3 /1 /� GW CONT / / DW CONT <br /> PETROLEUM / N PILOT Y / N ENTERED PILOT / / <br /> SITE NAME <br /> ADDRESS 1,2AI(151 <br /> PHONE <br /> CITY STATE CA ZIP 3 <br /> CONTACT NAME CROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE <br /> MAILING/STREET ADDRESS _ <br /> CITY STATE Cxz- I <br /> ZIP Q <br /> CONTACT NAME PHONEI( �Z YS 5 <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> CONTACT NAMEo PHONE <br /> COMPANY NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT PHONE <br /> SJLHD CONTACT — <br /> iinr s4-di <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR N UAR !/� //�y PROP 65 v/ N S / / PRIORITY <br /> SITE STREET pG� STREET # / 2 cl <br /> 89-019 (IV) 5/89 CNTMFR <br />