Laserfiche WebLink
PHS/SAN JOt JIN COUNTY - ENVIRONMENTAL EALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE D /�/ BY REVIEWED BY DATE ENTERED /� /f�Q L-Y <br /> ADDITION: <br /> SWEEP'S # 2-- <br /> COMPUTER # DIST # �Z LOC CODE <br /> UGT FILE H W FILE LAND USE FILE F'WS FILE ILOT !'RCS <br /> FAILED PT / / SOIL CONT / / GW CONT �� /G/ � IDW CONT <br /> PETROLEUM Y / N ENTERED F'ILOT / / FROG/ELE-HENT <br /> SITE NAME ++I <br /> ,1 <br /> ADDRESS G - PHONE 11 <br /> CITY STATE Cn ZIP j( <br /> II <br /> CONTACT NAME CROSS STREET <br /> PROPERTY OWNER <br /> NAMEPHONE <br /> — I , I I .. �4 --- - <br /> MAILING/STREET ADDRESS 7� <br /> CITY STATE C ZIF <br /> CONTACT NAME /f�� f 'HONE <br /> RESPONSIBLE PARTY ( If different from Property Owner,) <br /> COMPANY NAME PHONE I <br /> I <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY FSTATEJ ZIP' <br /> CONSULTANT [PHONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # - DATE / / PROP 65 # - DATE ; <br /> STREET # SITE STREET �'l ��� PRIORITY , <br /> EH 23 070 (7/89) 89-19 ( IV) 7/89 CNTMFR <br />