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SJLHD CONTAMINATED SITE MFR FORM PAGE 1 <br /> NOTE: 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. ALL APPROPRIATE <br /> INFORMATION SHOULD BE FILLED OUT FOR ADDITIONS TO THE DATA BASE. <br /> UPDATE: SUBMITTED BY: <initials> DATE ENTERED: <br /> ADDITION : EDIT: DELETE: <check one> <br /> SWEEPS M : 2I'-IQ COMPI : DISTM : LOC CODE: <br /> FACILITY <br /> + NAME: Yl - IV " 1.fL r <br /> FACILITY STREET: 7y`i l� . Loc <abbreviate> <br /> FACILITY CITY: LO Cf I FAC STATE: C'I FAC ZIIP:: gSdgc) <br /> / FACILITY TEL : 209 /_,3�q I f (p9FACILITY CONTACT: of d Sr� <br /> O <br /> _J11 <br /> Y�QYC GYt✓) <br /> OWNER NAME: J! C d SO >� 13LrG C T LVA <br /> OWNER STREET: ��f( ( s i n i }l , LA-) CL S4 <br /> OWNER CITY:' L_C�C1 i OWNER STATE: OWNER ZIP: <br /> OWNER TEL: __aL9 ( ( (d 17 OWNER CONTACT: <br /> UGST FILE: H.W. FILE: _ LAND FILE: WATER FILE: <br /> FAILED PT: SOIL CONTAMINATION: _ CUBIC YDS : <br /> GROUND WATER CONT: SURFACE WATER CONTAMINATION: _ <br /> DRINKING WATER CONT: _ OTHER CONT: _ <T or F> <br /> TPH: BEN: _ TOL : XYL: _ ETHYL BEN: EDB: _ <br /> SOLVENTS : AROMATICS : METALS: v OTHER: <T or F> <br /> EH 23 070 ( 2 ) 2/88 <br />