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PHS/ JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIt',..) <br /> LOP PROGRAM MFR INPUT FORM <br /> i <br /> [UPDATE 1` C l BY i� + REVIEWED BY: DATE ENTERED- BY <br /> 1 l <br /> ADDITION-. EDIT: <br /> ENTERED PILOT SJ/PHS CONTACT _ SWEEPS #. PRIORITY <br /> COMP # L=CODE DIST PROGRAM/ELEMENT CODESITESPECIFIC QUARTERLY ,REPORT•INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE'COOEC` �1 SOURCE OF FUNDS S / ;F FED.EXEMPT Y. / N. PETROLEUM Y� / N <br /> 0lJ <br /> SITE NAME + �` DATE REPORTED <br /> ADDRESSV l DATE CONFIRMED �f <br /> le- <br /> CITYCA ZIP MULTIPLE RP's Y <br /> C VA / <br /> L SITE STATUS <br /> CASE TYPE CONTRACT'STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U (S / G D 1 2 4 5 7 8 9 <br /> RP SEARCH S I N R. DATE UNDERWAY r r_ 7 COMPLETED <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY _ L1_of COMPLETED <br /> REMEDIAL INVESTIGATION U U DATE UNDERWAY !. COMPLETED' <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y Ir N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5. 6 F DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 3 H o �- R W,� G 0 <br /> EXCAVATION STARTED ` CASE CLOSED Y R. w H DATE CLOSED <br /> i <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS. HU , . NA VS <br /> Primary /...i. - • Additional RESPONSIBLE,PARTY, ` <br /> sl. <br /> COMPANY NAME S ti ( Ove S rU PHONE ' <br /> CONTACT NAME Qom / �' A-! PHONE <br /> ADDRESS -0- �.j/1r1( G VG' C f <br /> �e'rj T�✓l F STA E V� ZIP Z Z O9 <br /> Cl TY <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 />