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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: C <initials> DATE ENTERED: <br /> ADDITION : ✓ EDIT: v DELETE: <check one> <br /> SWEEPS 1 : 12--�- COMPY : PE &I-L30DISTM : y' LOC CODE: © I <br /> FACILITY NAME: _Dor- p MQ'2dc� <br /> FACILITY STREET: � N �7hAnl <abbreviate> <br /> FACILITY CITY: S llloC0yj FAC STATE: CA FAC ZIP: 2 O� <br /> FACILITY TEL : 209 /_q3( -6Q FACILITY CONTACT: fjr�/ u9liPc <br /> OWNER NAME: ( erof(o M,,-z4 <br /> OWNER STREET: SoUrp a/ - Q v <br /> OWNER CITY :' OWNER STATE: OWNER ZIP: <br /> OWNER TEL : / OWNER CONTACT: <br /> C UGST FILE: V H.W. FILE: LAND FILE: _ WATER FILE: <br /> FAILED PT: _ SOIL CONTAMINATION: -Z CUBIC YDS : U KN <br /> GROUND WATER CONT: � SURFACE WATER CONTAMINATION: UIlCN <br /> DRINKI•NG WATER CtONNT: U/<,.. OTHER CONT: uKhj <T or F> <br /> TPH: 1 BEN: V TOL: XYL: t ETHYL BEN: EDB: _ <br /> SOLVENTS : AROMATICS: METALS : OTHER: <T or F> <br /> i <br /> EH 23 070 ( 2 ) 2/88 <br />