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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE / / BY REVIEWED BY DA'iE ENTERED / / / BY <br /> Zell <br /> ADDITION:— EDIT: <br /> SWEEPS # COMPUTER # �� DIST # -32O LOC CODE �Z <br /> UGT FILE H W FILELAND USE FILE PWS FILE PILOT PROD <br /> FAILED PT / / SOIL CONT 12 /21 / GW CONT / / DW CONT <br /> PETROLEUM Y / N ENTERED PILOT I PROG/ELEMENT <br /> SITE NAME S ) 7C <br /> ADDRESS .220 L OX-I-ltu lul- PHONE <br /> CITY STATE CA Z I P <br /> CONTACT NAMEJ �� � S CROSS STREET / <br /> PROPERTY OWNER <br /> NAME tl� -/ PHONE <br /> MAILING/STREET ADDRESS <br /> CITY I Lod; STATE C19- ZIP _9,52-�ZO <br /> CONTACT NAME � 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 06� c: M77-1 �E�N6LOC,-( TF�O7NE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # DATE 1Z /z /5-D JPROP 65 # - DATE 12_/2,, /cl,D <br /> STREET #L.s I <br /> SITE STREET -ckgr__U -ve / G2_ PRIORITY <br /> EH 23 070 (7/89) 89-19 (IV)7/89 CNTMFR /�� (� <br />