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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: A <initials> DATE ENTERED: <br /> ADDITION : EDIT: DELETE: <check one> <br /> SWEEPS 0 : COMP# : DIST# : / � LOC CODE: Z`•�� <br /> FACILITY NAME: <br /> FACILITY STREET: ZZS'3 Z /0, AlCUy 4 <abbreviate> <br /> r <br /> FACILITY CITY: FAC STATE: Com_ FAC ZIP: I �`�L� <br /> FACILITY TEL : 209 FACILITY CONTACT: !Jd�Loyet- <br /> OWNER N�AJME: D- <br /> OWNER STREET: U �L4' t` ToIJQ(i�� <br /> OWNER CITY :' ST r 7_ OWNER STATE: C k OWNER ZIP: e?-9—Z�Z <br /> OWNER TEL: ZOO/ / �7I - / Zc� OWNER CONTACT: S/4 <br /> UGST FILE: H.W. FILE: �� LAND FILE: WATER FILE: <br /> FAILED PT: SOIL CONTAMINATION: _L,� 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 : I/ OTHER: <T or F> <br /> �-H N 50 ( 1 of 2 ) <br /> 2/88 REVISED <br />