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0 <br /> PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE /2/2�,/ BY REVIEWED BY DATE ENTERED / / BY <br /> ADDITION: EDIT: <br /> SWEEPS # /��7 COMPUTER # Zj, � DIST # j� LOC C DE QI <br /> UGT FILEH W FILE LAND USE FILE PWS FILE PILOT PROS <br /> PRICED GT /� /qo SOIL CONT ,/2� / GW CONT DW CONT <br /> PETROLEUMY / N ENTERED PILOT / / GROG/ELEMENT <br /> SITE NAME <br /> ADDRESS ��� 1 GHONE (mac) 1f 3 <br /> W i� L <br /> CITY �OC4 -U._ STATE CA ZIP <br /> CONTACT NAME �� / CROSS STREET �_S <br /> PROPERTY OWNER <br /> NAME -1 COMQ�YUy PHONE (Lll$)b <br /> MAILING/STREET ADDRESS Po <br /> CITY OY7L�� _/ STATE CSI- ZIP' C�11 2- <br /> CONTACT NAME U PHONE ko c5-1 .Z��jrj fi.l <br /> RESPONSIBLE PARTY ( If different from Property Owner) <br /> COMPANY NAME S 4 PHONE <br /> CONTACT NAMEJ 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 +0 DATE /2/-26 /c PROP 65 # - DATE <br /> STREET # SITE STREET ) /n PRIORITY <br /> EH 23 070 (7/89) 89-19 (IV) 7/89 CNTMFR <br />