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PHS/90JP-'JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISymool <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE S.� BY REVIEWED BY ATE ENTERED DBy��el2j <br /> ADDITION• EDIT: V-ll^ 6 <br /> ENTERED PILOT SJ/PHS CONTACT Gj scwl�u,-c)e � SWEEPS # PRIORITY <br /> NOR SENT LOC CODE I Rq DIST PROGRAM/ELEMENT CODE -2 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 �Zp 3¢ 95 <br /> - <br /> SITE CODE q:�4's SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME ! <br /> 60 g i o2 DATE REPORTED <br /> ADDRESS 0 DATE CONFIRMED <br /> CITY �q'j� I/ CA ZIP I q j5ZD6 MULTIPLE RP's Y / Q <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U V G D 1 2 a 4 5 7 8 9 6 2$ •yZ <br /> RP SEARCH 0 I N R DATE UNDERWAY 8.17-512- <br /> ,'7,51Z COMPLETED Z, <br /> PRELIMINARY ASSESSMENT U D DATE UNDERWAY !� COMPLETED <br /> REMEDIAL INVESTIGATION U vx- DATE UNDERWAY 1 COMPLETED l0 <br /> REMEDIAL ACTION U I C DATE UNDERWAY ! 7._r.�Z COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY / COMPLETED <br /> ENFORCEMENT ACT TAKEN Y 0ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED �b •4- I / CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD ! CB ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAPE f,-Pr 1 1 C f PHONE <br /> CONTACT NAME dD 1 ilj � PHONE <br /> ADDRESS n` D . <br /> CITY STATE /)n ZIP G,6 7 fl <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 />