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PNS/SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR — INPUT FORM . <br /> UPDATE /)� /J( BY REVIEWED BY DATE ENTERED / / BY <br /> ADDITIONt EDIT: . <br /> SWEEPS # COMPUTER '# DIST # z [ LOC CODE 9f <br /> UGT FILE 7HW FILE LAND USE FILE PWS FILEJ PILOT FROG <br /> FAILED PT / / SOIL CONT /,Cv GW CONT / / DW CONT <br /> PETROLEUM N ENTERED PILOT / / PROD/ELEMENT �I <br /> SITE NAME <br /> ADDRESS PHONE <br /> CITY �4 ��ro STATE CA ZIP 9S Z%' <br /> CONTACT NAME.J _, a Q CROSS STREET <br /> PROPERTY OWNER <br /> NAME �, Il�1or'2� L/a ,-e rYrG, PHONE <br /> MAILING//S, REET ADDRESS �2Alp <br /> CITY �G � STATE �� ZIP <br /> CONTACT NAMEJ Z`5dl © PH <br /> RESPONSIBLE PARTY (If different from' Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE I ZIP <br /> CONSULTANTPHONE <br /> c jt in(- . 6 3 7 Z <br /> SJ/EH CONTACT <br /> RWGCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT F <br /> UAR # — DATE /' / PROP 65 DATE <br /> STREET # SITE STREET 'RIDRITY <br /> EH 23 070 (7/89) 89-19 ( IV)7/89 CNTMFR ; <br />