Laserfiche WebLink
PHS/SAN JUIN COUNTY - ENVIRONMENTAHEALTH DIVISION i <br /> TAMINATED SITE MFR - INPUT FORM . 4_ <br /> UPDATE ,0//y/fQ BY I REVIEWED BY DATE ENTERER r /�/ BY <br /> ADDITIONS EDIT: <br /> COMPUTER # DIST # Qj?,,7j LOC CODE <br /> t <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT PROS r <br /> FAILED PT / / SOIL CONT I /0 ,/Z y /ggo GW CONT / / DW CONT <br /> PETROLEUM lJ/ N ENTERED PILOT �D / !C� /g� PROG/ELEMENT 2 � i <br />�.. i <br /> SITE NAME Dta\, NA7vpjlZS LSCA <br /> ADDRESSGtr-f3WvL ZIP PHONE 4(,,6 g0II { <br /> CITY SSM STATE CA � et <br /> CONTACT NAME 4'p CROSS STREET <br /> PROPERTY OWNER <br /> NAME Ccri- �t1C . PHONE <br />+ MAILING/STREET ADDRESS �+ 315 <br /> CITY e,00.1 F'IZ^�V/4G4 STATE C/'+ ZIP <br /> CONTACT NAME j&AAqnb $4A PHONE (41S 442--55$(0 <br /> RESPONSIBLE PARTY (If different from Pro pj y-Own e' 'r) -� � <br /> COMPANY NAME S Vp* PHONE \ \ <br /> CONTACT NAME �$ 4 'PHONE r l <br /> QoahJ Fw2(t. t <br /> ADDRESS Q.O . C; <br /> CITY STATE ZIP <br /> - i <br /> CONSULTANT PHONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # p y u33 DATE `� /�3 / pg .PROP 65 I# - (� DATE /j 3 / <br /> STREET q 0 SITE STREET � �✓ PRIORITY <br /> EH,. 23 070 (7/89) 89-19 (IV)7/89 CNTMFR <br />