Laserfiche WebLink
PHS( `,jAQUIM COUNTY - ENVIRONMENTAL HEALTH DIV(,,.J <br /> LOP PROGRAM - MFR INPUT FORM ! <br /> LIPOATE ' _ O 2 BY REVIEWED BY "A' <br /> DATE EXTERED (�/ g <br /> 1 <br /> ADDITION: %e EDIT: <br /> ENTERED PILOT I p� SJ/PHS CONTACT �4 SWEEPS / U <br /> << U PRIORITY <br /> NOR SENT DIST 27 S PROGRAM/ELEMENT CODE 3 G� <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION d <br /> CONTRACTOR M 39000 SUBSTANCE K17/��� /�O� /0� 1�� <br /> SITE CODE <br /> 1773 SOURCE OF FUNDS S / FED EXEMPT Y / /M J PETROLEUM ( Yl / N <br /> SITE NAME / f r 6&4dt�il <br /> DATE REPORTED <br /> ADDRESS J� ©D D DATE CONFIRMED <br /> CITY CA ZIP ��J? MULTIPLE RP's Y / ON <br /> SITE STATUS OC�J <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U ^S 1G� D 1 ^2A 3 4 5 7 8 9 / q 1 <br /> RP SEARCH l S I N R DATE UNDERWAY (COMPLETED j <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U ! C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING YY N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN N ENFORCEMENT TYPE 2 3 4 5 6 DATE ACTION TAKEN <br /> �n) <br /> LOFT CONSIDERATION 1 2 3 i s C A W G 0 �3 <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN co co ED ET FP GT IT RS RU NA VS <br /> 1p <br /> _Primary / Additional RESPONSIBLE PARTY p2 02 4;,1f3 <br /> COMPANY NAME PHONE Q �^ 6 <br /> CONTACT NAME _ / 5 PHONE �D 7_ <br /> ADDRESS .0 <br /> CITY STATE ZIP <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE J C <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />