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PHS/SAN JO1 IN COUNTY - ENVIRONMENTAI EALTH DIVISION <br /> PILOT PROGRAM - MFR INPUT FORM <br /> UPDATE / . / f�, BY DATE ENTERED / / BY <br /> ADDITION: t✓ EDIT: DELETE: <br /> COMP 293 ILOC CODE I®Z DIST 2,D IPROG/ELEMENT CODE Z 3/�q <br /> ENTERED PILOT /�� / ]CONTAM MFR FILEDJOY / N PRIORITY <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR , 39000 [SOURCE OF FUNDS © / F SUBSTANCE I ;3� <br /> SITE CODE # � /� FED EXEMPT Y / PETROLEUM CY)/ N <br /> DATE REPORTED e5 J / DATE CONFIRMED /OS- / ��' CATEGORY ® / S <br /> SITE NAME ! U <br /> ADDRESS �-o & V <br /> CITY v STATE CA ZIP <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS EMERGENCY RESPONSE <br /> U / S / © / D 1 2 (�) 4 5 6 7 8 <br /> RP SEARCH / I / N / R DATE UNDERWAY /G� / COMPLETED <br /> PRELIM ASSESSMNT OU / C DATE UNDERWAY/ �S/ ? COMPLETED <br /> REMEDIAL INVEST U / C DATE UNDERWAY / / COMPLETED <br /> REMEDIAL ACTION U / C DATE UNDERWAY COMPLETED <br /> J COMPLETED <br /> DATE EXCAVATION STARTED b� / 06 / REME�-/DIAL ACTIONS TAKEN <br /> POST REMEDIAL ACTION MONITORING Y / N / U / C <br /> POST REMED ACT MONITOR DATE UNDERWAY / / COMPLETED <br /> ENFORCE ACT TAKEN Y / N DATE UNDERWAY / / COMPLETED <br /> ENFORCEMENT ACTION TYPE 1 / 2 / 3 / 4 / 5 / 6 <br /> CASE CLOSED Y / R / H DATE CASE CLOSED <br /> RESPONSIBLE PARTY <br /> COMPANY NAME W LS t ���, PHONE <br /> CONTACT NAME w�LS PHONE <br /> ADDRESS <br /> CITY z> bTv)\j I <br /> STATE ZIP <br /> EH 23 083 (6/89) 89-20 ( ) 5/89 PILMFR <br />