Laserfiche WebLink
PHS/SAN JOhVUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM . <br /> UPDATE /gyp /)D BY � REVIEWED BY , DATE ENTERED <br /> ADDITION: EDIT: .�� / <br /> SWEEPS # IO-�� COMPUTER # 1 -PR lc;Tq 1� DIST # JF 321 LOC CODElqq <br /> UST FILE 7H W FILE LAND USE FILE PWS FILE PILOT PROD <br /> FAILED PT / / SOIL CONT /30 t� GW CONT / / DW CONT <br /> PETROLEUMT/ N I ENTERED PILOT / / PROG/ELEMENT <br /> SITE NAME -PA IC 5 r, rJiCP� <br /> ADDRESS l O-� ( vC �as PHONE <br /> CITYJ GJ .�Z>� STATE CA ZIP <br /> CONTACT NAME I M �� � CROSS STREET �I S <br /> PROPERTY OWNER 1 <br /> NAME f PHONE (Zoei) Lf-?-7-(-D_ u <br /> MAILING/STREET ADDRESS <br /> CITY STATE ZIP <br /> CONTACT NAMEJ 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 # �� - UQ (e) DATE /n/q PROP 65 # - DATE /-�b /qo <br /> STREET # SC) SITE STREET F'RIDRITY <br /> __j <br /> EH 23 070 (7/89) 89-19 (IV) 7/84 CNTMFP <br />