Laserfiche WebLink
F <br /> .,`��r�,y4•��ya':' . !ti Vii:-- - _ :r �-+ .� ENVIR <br /> "y�"'k'`'••i',''<.'' ' ' PHS/SAN .10AQUIN COUNTY ONMENTAL HEALTH DIVISION <br /> ,..l.:. ..5. <br /> CONTAMINATED SITE MFR _ INPUT FORM <br /> '' '::••:, ' UPDATE /a, /v BY �.�� REVIEWED BY DATE. ENTERED / / BY <br /> v' <br /> I` ADDITION: <br /> SWEEPS # COMPUTER # DG�rA 3..5 DIST # 3 as LGC CODE <br /> U13T FILE H W FILE LAND USE FILE GWS FlLETj ;PILOT PRCG <br /> FAILED PT / / SOIL CONT GW CONT % / DW CONT <br /> PETROLEUM Y N ENTERED PILOT / / PROD/ELEMENT <br /> SITE NAME JCC' L S. <br /> ADDRESS 35.3 -S E['���i-o PHONE <br /> CITY �-51-va& STATE Cn ZIP ysaos <br /> CDNTACTNAME tom, &2oC>AS e Ne-FY/,_ [CROSS STREET <br /> PROPERTY OWNER <br /> NAME Q Tau G� SC, /es PHONE <br /> MAILING/STREET ADDRESScer <br /> CITY STATE Z IF-' 95� OS� <br /> CONTACT NAME �i~uCP (�ac.� A, F�HONE <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE i <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE 7IF' <br /> 4 <br /> CONSULTANT Lir NCird/, PHDNE <br /> s hoc/fin -SPrv�G e Sc. fr�ir� ycn4! b'.333 <br /> SJ/EH CONTACT <br /> RWQCB CONTACT C� / <br /> DHS CONTACT <br /> OTHER CONTACT <br /> 4' <br /> UAR # - DATE JPROP 65 # SC 11-- C( ' DATE if /j, <br /> +� U <br /> STREET #i 3 S SITE STREET PRIORITY <br /> F <br />