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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HcALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE j / �Z /� BY I C, }7 DATE ENTERED / /G� By <br /> ADDITION: K t7 EDIT: DELETE: X33 <br /> SWEEPS # 7i 3 COMPUTER # u lo� I DIST # 32/ LOC CODE <br /> UGT FILE ✓ H W FILE LAND USE FILEI IPWS FILEI IPTLOT PROG 139 9 <br /> FAILED PT / / SOIL CONT / / GW CONT <br /> 3 /� / DW CONT <br /> PETROLEUM' / N ENTERED PILOT / IL / gc'1 PROG/ELEMENT 23 <br /> SITE NAME Uri` ( ✓1/V�CP �o✓t a7S--$ <br /> ADDRESS /G 6 S PHONE <br /> CITY SL 7CROSS <br /> CA ZIPCONTACT NAME L / STREET <br /> PROPERTY OWNER T v <br /> NAME <br /> �,,� �o �i` pir/ �✓/t PHONE /S <br /> MAILING/STREET ADDRESS7s // 6� <br /> CITY STATEZIP' 9[�s_ 2 <br /> .76 <br /> CONTACT NAME L J S�vr� vi PHONE <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME ^ PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT f s J PHONE 7�6 y5o?- a c� <br /> SJ/EH CONTACT <br /> ✓ a J' <br /> RWQCB CONTACT <br /> DHS CONTACT! <br /> OTHER CONTACT <br /> UAR Yi / N UAR 3 / / PROP 65 (Y / N '� / // PRIORITY <br /> SITE STREET VC <br /> STREET # 6 b S <br /> -J/ ci <br /> EtC 23 070 (6/89) 89-19 (IV) 5/89 CNTMFR <br />