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RHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE (- <br /> 1C-6 BY REVIEWED BYI al DATE ENTERED ?//�J/ >� <br /> ADDITION• EDIT: (_ <br /> SWEEPS # COMGUTER # / DIST # ; ` / <br /> 3 ' VcT Y_' LOC CODE G/ <br /> UGT FILE H W FILE LAND USE FILE PWS FILE PILOT FROG <br /> FAILED PT / �^�/ SOIL CONT / / GW CONT / / DW CONT <br /> PETROLEUM YJ / N I ENTERED PILOT / / PROS/ELEMENT <br /> SITE NAME <br /> RDDRESS PHONE <br /> CITY _517,_K r / STATE CA ZIP C -, <br /> CONTACT NRME /(�f�ajJ��T � Lt l}L CROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE <br /> MAILING/STREET ADDRESS &Z=; �� UL tf 7.5 <br /> CITY �r��-� �i'9C '�' STATE ZIF' �{�2 ;� <br /> CONTACT NAME « n,' L� y :/�5 7L'-C- PHONE �3LI <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME � - PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> CONSULTANT F'HONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # - DATE / ,R- PROP 65 # - DATE <br /> STREET # C SITE STREET PRIORITY <br /> J <br /> fi l <br /> EH 23 070 (7/89) 89-19 ( IV)7/89 CNTMFR <br />