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PHS/SAN JOW N COUNTY - ENVIRONMENTAL16EALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATEI/O / / () 1 BY 7� REVIEWED BY DATE ENTERED /D / / BY <br /> — ADDITION :-X... EDIT ...... <br /> SWEEPS # Z1G2 COMPUTER # �, 5 DIST # 37ZZ- LOC CODE <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT PROG <br /> FAILED PT / / SOIL CONT VZ/g-,5 GW CONT �Q //7 /g5 jDW CONT <br /> PETROLEUM ( / N I ENTERED PILOT I PROG/ELEMENT Z 3 <br /> SITE NAME <br /> ADDRESS 560a Ae,,t PHONE <br /> CITY G, STATE CA I ZIP ,SZ07 <br /> CONTACT NAME � CROSS STREET1 4/064 60 <br /> PROPERTY OWNER <br /> NAME �C NPi S PHONE <br /> MAILING/STREET ADDRESS a K/ O j/,�-. PO <br /> CITY ��ek STATE C. ZIP ll'- Sa(J7 <br /> CONTACT NAME ,A� St�7 PHONE <br /> RESPONSIBLE PARTY ( If different from Property Owner) / <br /> COMPANY NAME ,'/ PHONE y�s S_7`j ;"� <br /> CONTACT NAME 7TmO PHONE <br /> ADDRESS • O• (aQXS-175 <br /> CITY LJ4 riu} cree �--- I STATE `' ZIP s <br /> CONSULTANT A r O 1c, lo e-ei PHONE ' <br /> SJ/EH CONTACT <br /> RWQCB CONTACT j <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # - DATE I PROP 65 #JV000WWNM DATE IV <br /> STREET # ISITE STREET AC,`//, PRIORITY <br /> EH 23 070 ( 7/89 ) 89-19 ( IV) 7/89 CNTMFR <br />