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SJLHD CONTAMINATED SITE MFR FORM PAGE 1 <br /> NOTE: <br /> THIS FORM IS TO BE USED FOR ADDING, DELETING AND EDITING <br /> INFORMATION FOR THE CONTAMINATED SITES DATA BASE. ONLY THE <br /> SWEEPS NUMBER AND. FACILITY NAME WILL BE REQUIRED TO 'IDENTIFY THE <br /> APPROPRIATE RECORD FOR EDITS AND DELETES . j!ALL APPROPRIATE ; <br /> INFORMATION SHOULD BE FILLED OUT FOR ADDITIONS TO THE DATA BASE. j <br /> L > "DATE ENTERED: <br /> itfals � -- <br /> UPDATE: <br /> SUBMITTED <br /> ADDITION : V, EDIT: DELETE: <check one> <br /> f <br /> �I J <br /> SWEEPS # : j{� COMP# Z-Z)66v'y0 DIST# : �� LOC CODE: <br /> FACILITY. NAME: Q'u <br /> FACILITY STREET: 30 q 140 2` <abbreviate> <br /> r E+ <br /> FACILITY CITY: Lob FAC STATE: CA FAC! ZIP: <br /> FACILITY TEL : 209 /2G�II Ie2� FACILITY CONTACT: E y� <br /> f <br /> DOWNER NAME: SIX <br /> OWNER STREET: sI <br /> fr <br /> OWNER CITY- _ S _ _ OWNER STATE- OWNER ZIP: <br /> OWNER TEL: -J 7 OWNER CONTACT: <br /> Ir 1 f, <br /> UGST FILE: ✓J H.W. FILE: LAND FILE: WATER FILE: <br /> FAILED PT: V/ SOIL CONTAMINATION: CUBIC YDS : : <br /> GROUND WATER CONT: SURFACE WATER CONTAMINATION: <br /> DRINKING WATER CONT: OTHER CONT: <T orfF> <br /> ip LTJ . <br /> TPH: BEN: TOL: XYL: ETHYL BEN: EDB: <br /> OF>SOLVENTS : AROMATICS : METALS : OTHER: <T or <br /> EH N 50 ( 1 of 2 ) <br /> 2/88 REVISED <br /> copy <br /> ily <br />