Laserfiche WebLink
I <br /> n r � � <br /> PHS)�4WLADUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS " <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE r Z 2 J� ' •' BY " J �6W REVIEWED BY DATE ENTERED <br /> If it <br /> ADDITION: EDIT:. l <br /> / <br /> ENTERED LOP //�I Z /� SJ/PHS CONTACT (.tJ67 , . .,,-J may'"' PRIORITY { <br /> NOR SENT LOC CODE o 2 DIST. ®G+` PROGRAM/ELEMENT CODE 3z�' <br /> ✓ �! <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> 1 <br /> 661q 12(A5 ffL if <br /> !CONTRACTOR # 39000 SUBSTANCE #1 V�TE CODE 1330 SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEl11 Y / N� <br /> I <br /> SITE NAME C(-(yOF log/ PVELIC SAFE7ry 406, / L'6�l DATE REPORTED /DI A98 <br /> I r� p <br /> ADDRESS z 'S �,..� DATE CONFIRMED ���J� �)� <br /> CITY ✓60 <br /> CA IIP <br /> I <br /> LQ P 1 MULTIPLE RPS Y / N <br /> SITE STATUS I� <br />� � r <br /> CASE TYPE. r CONTRACT STATUS +a STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 6 7 8 <br /> RP SEARCH S [ 'N R '' DATE UNDERWAY I -�6 COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED 1 <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY CC14PLETED <br /> REMEDIAL ACTION U I C' DATE UNDERWAY COMPLETED it <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED {tt� <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE n 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 3 �� �,� W G 0 �I <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED fk <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP. GT IT !� RS HU NA VS VE NT OT �i UK <br /> �/ % Primary / .9_Addi tL�iio�n�l RESP/ON�SI/BLE PARTY <br /> COMPANY NAME C l-r/ Q r z✓ t Poette r CVq PHONE 0 <br /> CONTACT NAME (C�/A(�I� /"� ! Mrl" ,' PHONE <br /> ADDRESSZ� y 1 lI • 6 <br /> CITY STATE CA ZIP ,,� <br /> r <br /> Additi ons L RP's Listed on REVERSE SIDE ;; CONTAMINATED MFR INFO on REVERSE <br /> 4 <br /> 89-20(IV)01/90 PILMFA <br /> EH 23 083(09/89)REVISED 8/92 <br /> li <br />