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t. • <br /> SJLHD CONTAMINATED SITE MFR FORM 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 FILLED OUT FOR ADDITIONS TO THE DATA BASE. <br /> 2 <br /> UPDATE: 3 - y SUBMITTED BY: �105 <initlals> DATE ENTERED: <br /> ADDITION : EDIT: DELETE: <check one> <br /> --------------------------- <br /> SWEEPS Y : /D COMPY : 1 ` y <br /> �• DISTY : ��' LOC CODE: C? <br /> FACILITY NAME:��y -J7VGkiGi✓ U>rs Cfj�q� C�� �� <br /> FACILITY STREET: S��S� �, �F�/%Fie �T <br /> <abbrevlate> <br /> FACILITY CITY: FAC STATE: _ CA FAC ZIP: SZnnO_� <br /> FACILITY TEL : 209 /_ / L%j-iJ�V FACILITY CONTACT: /`7// �/1N f <br /> OWNER NAME: ISG 7`-& cp/Li 4-1,ly <br /> OWNER STREET: (' <br /> OWNER CITY :' OWNER STATE: < f� OWNER ZIP: <br /> C <br /> OWNER TEL: Z-1� >'-370- Dp OWNER CONTACT: N//l {,4F/y/A/ETy— <br /> UGST FILE: H.H. FILE: _ LAND FILLE: _ WATER FILE: <br /> ' _ <br /> FAILED PT: SOIL CONTAMINATION: ✓ CUBIC YDS : <br /> GROUND WATER CONT: SURFACE WATER CONTAMINATION: _ <br /> DRINKING <br /> WATER CONT: _ OTHER CONT: _ <T or F> <br /> TPH: BEN: TOL: _ XYL: _ ETHYL BEN: V EDD: _ <br /> SOLVENTS : AROMATICS: _ METALS: _ OTHER : <T or F> <br /> r <br /> EH 23 070 ( 2 ) 2/88 <br />