Laserfiche WebLink
PHS/SAN JO N COUNTY — ENVIRONMENTAL ALTH DIVISION <br /> CONTAMINATED SITE MFR — INPUT FORM <br /> UPDATE / /70 <br /> BY REVIEWED BYDATE ENTERED / / BY <br /> ADDITION: EDIT:, „_.. <br /> SWEEPS # wig COMPUTER # DIST # z5— ILOC CODE <br /> - UGT FILE 1 H W FILE LAND USE FILE PWS FILE PILOT FROG I <br /> FAILED PT SOIL CONT /� /q® GW CONT / / DW CGNT <br /> PETROLEUM( Y N ENTERED PILOT / / FROG/ELEMENT o2 7c <br /> SITE NAME <br /> ADDRESS PHONE <br /> CITY STATE CA ZIP c7 33 , <br /> CONTACT NAME CROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE <br /> as <br /> MAILING/STREET ADDRESS <br /> CITY STATE ZIP <br /> CONTACT NAME PHONE <br /> RESPONSIBLE PARTY (If different from Property Owner) <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY <br /> STATE ZIP <br /> CONSULTANT PHONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # — DATE y /�Q /90 PROP 65 # -- DATE <br /> STREET # ------- SITE STREET PRIORITY <br /> EH 23 070 (7/89) 89-19 (IV)7/89 CNTMFR <br />