Laserfiche WebLink
PHS/SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM . <br /> UPDATE BY REVIEWED BYWI DATE ENTERED I 1BY <br /> 1 I <br /> ADDITION:- EDIT: <br /> SWEEPS # COMPUTER # DIST # LOC CODE <br /> UGT FILE H W FILE E FILE F-1WS FILE PILOT PROG <br /> FAILED PT ISOIL CONT GW CONT DW CONT <br /> PETROLEUM N" I ENTERED PILOT PROG/ELEMENT <br /> SITE NAME <br /> ADDRESSIds 6-5001 <br /> / 0/7 PHONE yD�' <br /> CITY1 I STATE CA ZIPI <br /> CONTACT NAME CROSS STREET <br /> PROPERTY OWNER <br /> NAMEJ fii✓ ,,/ <br /> PHONE <br /> MAILING/STREET ADDRESS <br /> CITY1I STATE IZIP <br /> CONTACT NAME PHONE <br /> RESPONSIBLE PARTY (If differentfromProperty Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANTPHONE <br /> e'5 "e, 11-,�61 <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # DATE PROP 65 # DATEI Ik lgv <br /> STREET #T SITE STREETPRIORITY T <br /> EH 23 070 (7/89) 89-19 (IV)7/89 CNTMFR <br />