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PHSAWwr JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D1VI5,.We <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE 02 CP ry� BY �� REVIEWED BY DATE ENTERED /jl✓! - �� BY <br /> ADDITION: EDIT: <br /> ENTERED PILOT /yZ SJ/PHS CONTACT �i SWEEPS # / / PRIORITY <br /> NOR SENT �c� LOC CODE DIST 7jPROGRAM/ELEMENT CODE a �J <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 ¢v/e <br /> SITE CODE Mo SOURCE OF FUNDS / F FED EXEMPT Y / PETROLEUM / N <br /> SITE NAME d v / DATE REPORTED Z <br /> ADDRESS rr / DATE CONFIRMED <br /> CITY ••• ICA_J.ZIP_i Fr7o J.MULTIPLE RP's Y G / <br /> SITE STATUS 6 <br /> CASE TYPE j� CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U G D 1 2 / 31 4 5 7 8 9 <br /> RP SEARCH i N R DATE UNDERWAY ry G�'� COMPLETED <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY �z COMPLETED <br /> ` C <br /> REMEDIAL INVESTIGATION U W.C. DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN N ENFORCEMENT TYPE 2 3 4 5 b DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H� S n R W G 0 f �j <br /> EXCAVATION STARTED CASE CLOSED 7 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 r r <br /> COMPANY NAME %G'1 �� p PHONE G <br /> CONTACT NAME �? PHONE J r - <br /> ADDRESS Co 0 {�� (p <br /> ETY <br /> w STATE /f - ZIP <br /> Additional RP's Listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11190 89-20(IV)01/90 PILMFA <br />