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PHS/SAN JOROW COUNTY - ENVIRONMENTALLTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT rORII <br /> ' UPDATE /,rj/„/L BY REVIEWED BY DATE ENTEREDI? /)��/G j 2.Y <br /> ADDITION • EDIT- <br /> SWEEP'S # COMPUTER # .- . 7 DIST # LOC CODE —I <br /> I <br /> --1 <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT PRCG I <br /> FAILED PT / / SOIL CONT )P / /(E GW CONT / / DW CONT <br /> PETROLEUM Y / N ENTERED F'ILOT / / FROG/ELEMENT - 86 <br /> SITE NAME Mtt 121zi u_ ESTE <br /> .—, f I <br /> ADDRESS •� 5. MuL ef <br /> PHONE Lj L/ <br /> CITY <br /> CITY STATE CA ZIP <br /> CONTACT NAME r1 CROSS STREET VA L., �� a <br /> P'ROP'ERTY OWNER <br /> NAME 46me,4" <br /> L— <br /> MAILING/STREET ADDRESS ZLI,I) <br /> CITY i STATE <br /> I C? <br /> CONTACT NAME 6L I PHONE <br /> RESPONSIBLE PARTY ( If different from Property Owner) <br /> COMPANY NAME J y, > PHONE <br /> I <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE: ZIP <br /> CONSULTANT F'HONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> I <br /> UAR # -� DATE =DATEA / L� / <br /> 1 -� � <br /> STREET # SITE STREET PRIORITY <br /> 7 a( K <br /> EH 23 070 (7/89) 89-19 ( IV) 7/89 CNTMFR <br />