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1 F� JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVTj� <br /> !LOP,PROGRAM MFR INPUT FORM C' <br /> UPDATE BY REVIEWED BY DATE ENTERED BY <br /> ADDITION: EDIT:— <br /> ENTERED PILOT SJ/PHS CONTACT SWEEPS # PRIORITY <br /> NOR SENT LOC CODE 3 DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39900 SUBSTANCE #1 5 <br /> I <br /> SITE CODE SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N. <br /> SITE NAME - DATE REPORTED <br /> I <br /> ADDRESS _ DATE CONFIRMED <br /> t <br /> r }" CA TIP <br /> CITY MULTIPLE RP's Y / N <br /> i <br /> 't SITE STATUS . f <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY'RESPONSE i <br /> U S ^ G D 2 A3 4 5. 7 r 8 9 <br /> } _ <br /> RP SEARCH S, v I ,N R DATE UNDERWAY - COMPLETED <br /> - I <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY - COMPLETED <br /> REMEDIAL INVESTIGATION U DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U �I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MON17ORING Y N U sr C DATE UNDERWAY COMPLETED <br /> a ' <br /> ENFORCEMENT ACT TAKEN Y;. N 1 ENFORCEMENT TYPE '41� 2 3 4 5 6 DATE ACTION TAKEN <br /> F. <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> 4 � 1 <br /> * � CASE CLOSED Y R H e I. ,�DATE CLOSED" <br /> EXCAVATION STARTED # 1 ' <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE*PARTY <br /> F ; ' PHONE <br /> COMPANY NAME 3 q• �- <br /> CONTACT NAME R PHONE <br /> txa . <br /> ADDRESS <br /> .CITY ' tw TSTATE' TIP - <br /> ti <br /> Additional RP's listed on REVERSE SIDE y a CONTAMINATED MFR INFO on REVERSE SIDE <br /> S- T <br /> 89-20(IV)01/9O'PILMFA <br /> EH 23 083(09/89)REVlS>D 11/90 A a <br />