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PHSJUJOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI ­�; II <br /> LOP PROGRAM -k,MFR .INPUT FORM <br /> UPDATE / K Z BY REVIEWED BY p ENTEREDT - BY <br /> d ADDITION: � EDIT: �° 1 <br /> ENTERED 21reV �r. q� SJ/PHS CONTACT SWEEPS.# ZS R PRIORITY . <br /> I,L <br /> NOR SENT LOC CODE GL DIST PROGRAM/ELEMENT CODE '-'7G�`- <br /> C J <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATIONI <br /> CONTRACTOR # 39000 SUBSTANCE #11 <br /> 17z <br /> /��C��/ .h• w, <br /> SITE CODE SOURCE'OF FUNDS S / F FED EXEMPT Y / JPETkOLEUM /, _",N <br /> 4 <br /> SITE NAMEzazIr br/� 0 I DATE REPORTED <br /> �/'� <br /> ADDRESS 2 :;7,,, �0� DATE CONFIRMED <br /> d L 6 <br /> CITY ! CA ZIP FrZ.O� MULTIPLE RP's / N f <br /> G <br /> ra <br /> SITE:;STATUS <br /> CASE TYPE CONTRACT STATUS! STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U SV G D 1 2 3 4 5 � / 8 9 ,/z Q2 <br /> RP SEARCH �5 1 N R DATE UNDERWAY �_�TZ COMPLETED <br /> PRELIMINARY ASSESSMENT U DATE UNDERWAY „ E COMPLETED 6 ✓�/`-;G9� <br /> /z 0 D~ 7'/ o G <br /> REMEDIAL INVESTIGATION U I J DATE UNDERWAY r� _Q COMPLETE--�ED <br /> N. 4 <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED v <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y ENFORCEMENT TYPE14'. 1 2 3 4 5 • b.; DATE ACTION-.,TAKEN ti <br /> T <br /> LUFT CONSIDERATION 1 2 3 S �. W . G 0 <br /> EXCAVATION STARTED CASE CLOSED Y:' - R y H DATE,CLOSED-- <br /> REMEDIAL ACTION TAKEN CD co ED ET i FP GT 1T RS .HU NA VS <br /> P. i <br /> Primary / Additional RESPONSIBLE PARTY :ry' <br /> COMPANY NAME f' / �: PHONE d I?- 1 /� 9 <br /> d C <br /> CONTACT NAME r ' /� &&ZZ s PHONE <br /> ADDRESS 1 GG L K G <br /> A i ' <br /> CITY G. µ : STATE ZIP <br /> IN N <br /> Additional RP's listed on REVERSE SIDE 1� ;b CONTAMINATED MFR INFO on REVERSE SIDE 1 <br /> IF � <br /> 89-20(IV)01/90 PILMFA <br /> EH 23 083(09/89)REVISED 11/90 _ ,' ,{ <br />