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f 4 <br /> f�! <br /> PHO, JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVN <br /> j a LOP PROGRAM - MFR INPUT FORM <br /> Y <br /> [UPDATE BY REVIEWED BY DATE ENTERED ,s `j BY <br /> ADDITION• EDIT: l <br /> li <br /> ENTERED PILOT 16)2)� SJ/PHS CONTACT , ` �r SWEEPS # PRIORITY } <br /> •: L/�,Y 555LLL��� i <br /> NOR SENT LOC CODE DIST <br /> [PROGRA. /ELEMENT CODE 2.3So <br /> iSITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 139000 SUBSTANCE #1 �/�� 5 <br /> SITE CODE G, SOURCE OF FUNDS 5 / F FED EXEMPT Y / PETROLEUM /Y J / N <br /> SITE NAME I ,I , "`�Lc) 4 DATE REPORTED ( �7 <br /> ADDRESS �( (� u E _�7 DATE CONFIRMED 1 �f+ <br /> --F <br /> CITY u�r+ ,f � �y v CA 2IP � MULTIPLE RP�s Y / <br /> lh't H <br /> SITE STATUS <br /> CASE TYPE " CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U (3) G D 1 2 i; 3 14 U 5 7 1.8 <br /> 9 <br /> L..// <br /> RP SEARCH I N A R DATE UNDERWAY �L Q COMPLETED <br /> PRELIMINARY ASSESSMENT U h C DATE UNDERWAY COMPLETED i <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> x ENFORCEMENT ACT TAKEN Y NENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> ,I <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> Ir <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT R5 HU NA V5 <br /> { Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME /�ifJ �1 W ii r PHONE j <br /> l-} 1�LXJ IN �] i <br /> CONTACT NAME &AJ r�// PHONE 4 J E� ( -;)-4k <br /> ADDRESS �.V n �I C/1� <br /> CITY ��j I STATE ZIP <br /> i <br /> I <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />