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- . <br />� . <br /> PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> [UPDATE BYJ 7z- tREVIEWED BY 14-1 DATE EN ERED B <br /> SWEEPS # ICOMPUTER IDIST # 1 3,;k D- 1 LOC CODE <br /> UGT FILE FILE T 7LAND USE FILE PWS FILE PILOT PROG <br /> FAILED PT ISOIL CONTI GW CONT I DW C ET <br /> SITE NAME re <br /> L y <br /> ADDRESS PHONE <br /> CITY1 STATE CA ZIPI <br /> CONTACT NAME �lc ROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE L�i <br /> — I --:4'W_ 4 4,1 <br /> o <br /> STATE ZIP <br /> CITY Li <br /> CONTACT NAMEJ <br /> 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 PHONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # LA L-1 e> JDATE PROP 65 #h DATEJ/,;� /4/ ltf� <br /> STREET # 1 --TE STREET I PRIORITY <br /> ^ EH 23 070 (7/S9) 89-19 (%V)7/89 CNTMFR ^ <br />