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SJLHD CONTAMINATED SITE MFR FORM <br /> 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 FILLLEEDD OUT FOR ADDITIONS TO THE DATA BASE. <br /> UPDATE: �� 7 O/ SUBMITTED BY: <initials> DATE ENTERED: <br /> ADDITION : ✓ EDIT: DELETE: <check one> <br /> SWEEPS M : _� COMPY : 41196635D DIST# : _ LOC CODE: <br /> FACILITY NAME: � <br /> FACILITY STREET: /���,,,�5`-6�0 C F. 0a- <abbreviate> <br /> FACILITY CITY: �TJ'rn0/� FAC STATE: CA FAC ZIP: ?5330 <br /> / FACILITY TEL : 209 / F/ACILITY CONTACT: 207L a04�11� <br /> l OWNER NAME: <br /> OWNER STREET: " �f0 �q� <br /> OWNER CITY :' / eJ OWNER STATE: `"` U OWNER ZIP: �30S <br /> OWNER TEL: OWNER CONTACT: <br /> C UGST FILE: <br /> H.W,. FILE: LAND FILE: WATER FILE: _ <br /> FAILED PT: V SOIL CONTAMINATION: _ CUBIC YDS : <br /> GROUND WATER CONT: _ SURFACE WATER CONTAMINATION: _ <br /> DRINKING WATER CONT: _ OTHER CONT: /_ <T or F> <br /> TPH: �EN: `, TOL: ✓ XYL: ✓ ETHYL BEN: ✓ EDB: _ <br /> SOLVENTS : AROMATICS: _ METALS : _ OTHER: <T or F> <br /> EH 23 070 ( 2 ) 2/88 <br />