Laserfiche WebLink
PHSJOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI <br /> LOP PROGRAM - MFR INPUT FORM <br /> c� <br /> UPDATE (✓ BY ��b REVIEWED BY E ]DATE ENTERED MAR 3 0 1994 B <br /> ADDITION:-Z— EDIT• 'H" .-- <br /> ENTERED LOP k1l"Oq SJ/PHS CONTACT SD PRIORITY LOP <br /> NOR SEAT LOC CODE DIST PROGRAM/ELEMENT CODE 35 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION a <br /> CONTRACTOR # 39000 SUBSTANCE #1 2 3 Z 2 <br /> SITE CODE =SOURCE OF FUNDS I S / FED EXEMPT Y / :� PETROLEUM Y / N <br /> SITE NAME O/°' y� vc) <br /> m DATE REPORTED / 1 �3 <br /> ADDRESS ��`///"` DATE 'CONFIRMED <br /> CITY STUB]l CA ZIP � MULT,IPLE RPIS Y / <br /> !l• �'VV SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE.', EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5AM <br /> 7 8 <br /> RP SEARCH �S I N DATE UNDERWAY [� G'j y COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY cr �4 COMPLETED �fl <br /> • l <br /> REMEDIAL INVESTIGATION U DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U ( CJ DATE UNDERWAY 2 1� qV COMPLETED <br /> yk: t-J J I ( ( j <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN p YJ N ENFORCEMENT TYPE 2 3 4 5 6 a DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 3 �I ( S ,) O � W G 0 <br /> EXCAVATION STARTED 7 l q CASE CLOSED v/ R C L" DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CS ED ET FP GT_ IT RS HU NA' VS , VE It NT OT UK <br /> . t <br /> Primary / .Additional RESPONSIBLE PARTY <br /> COMPANY NAME S+ C PHONE <br /> CONTACT NAME /�j PHONE r <br /> ADDRESS <br /> CITY `YJ" / ` STATE 1 / ZI <br /> LP' <br /> 11 <br /> AdditioneL RP's Listed on REVERSE SIDE I ° CONTAMINATED MFR INFO on REVERSE SIDE ; <br /> y <br /> EH 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />