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PHSI(}� 1 E/ <br /> a )JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI(j <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE T BY REVIEWED BY DATE ENTERED BY ' <br /> t d e�7;4 ADDITION-_ EDIT:'/ <br /> ENTERED PILOT /,)0 SJ/PHS CONTACT j1�Lri SWEEPS #" L.1 -!L) PRIORITY <br /> NOR SENT -, ,U LOC CODE 9� DIST ��'Z PROGRAM/ELEMENT CODE1906 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 /7� 3y 5 <br /> SITE CCOE l s-/�V SOURCE OF FUNDS/ SO <br /> FED EXEMPT Y / I N 1' PETROLEUM Y / N <br /> SITE NAME S-� co, / ] � `( \DATE REPORTED <br /> !�7 <br /> ADDRESSc Ai <br /> 7 0 7 DATE CONFIRMED <br /> ( �✓ C� ( I <br /> CITY • - CA ZIP Gj��fJb MULTIPLE RP's Y / k <br /> SITE STATUS / Y 'f <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> I <br /> U OS <br /> G D 1 2 3 4• 5 7 8 <br /> RP SEARCH V I N R DATE UNDERWAY Fb COMPLETED 9/3 <br /> 7 0 <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY /0 q O COMPLETED J !' <br /> REMEDIAL INVESTIGATION U #,C• DATE UNDERWAY COMPLETED -) / <br /> REMEDIAL ACTION U I DATE UNDERWAY I Z-' '' /_' � COMPLETED [ d 1 <br /> POST REM ACT MONITORING Y U C DATE UNDERWAY _( COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> N, I <br /> - may. 'A�. <br /> LOFT CONSID`iTION y" ^`-C /a� A R' W G b <br /> l� � <br /> EXCAVATION STARTED /Z O CASE CLOSED Y R H DATE CLOSED I <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> j _Primary / '_II Additional RESPONSIBLE PARTY <br /> COMPANY NAME S, J / ,� , (Ni PHONE / T7i 3000 <br /> CONTACT NAME `1 PHONE <br /> Pi <br /> ADDRESS o, (-?,b(-?,bk/ /P b <br /> CITY 1` •� !/ STATE (11 ZIP '7_C2.j <br /> Additi mat RPIS Listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />