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PHSi nJOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVItn <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE I BY REVIEWED BY DATE ENTERED BY <br /> ADD ITION:-/EDIT• <br /> ENTERED PILOTJ^�•9 1 SJ/PHS CONTACT cJ SWEEPS # /2,+B PRIORITY <br /> NOR SENT LOC CODE 2 DIST J� PROGRAM/ELEMENT CODE 22) <br /> I <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION , <br /> I <br /> CONTRACTOR # 39000 SUBSTANCE #1 19 5 ' <br /> SITE CODE SOURCE OF FUNDS S / /F JTIEDk <br /> E <br /> / PETROLEUM � / N <br /> SITE NAME <br /> " DATE REPORTED <br /> VHOW6e� �M /J0j <br /> ADDRESS 2 •�' <br /> 1 1S�J� �' DATE CONFIRMED ?, •Z"� I <br /> CITY L 1 y3 V" CA ZIPC/� 0 MULTIPLE RP's Y <br /> y✓ f i <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U QS G DD 1 2 O3 4 5 7 8 9 <br /> RP SEARCH ( SJ I N R DATE UNDERWAY COMPLETED q <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY �. CCMPLETED <br /> REMEDIAL. INVESTIGATION U g(C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED `r <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED 1 <br /> ENFORCEMENT ACT TAKEN Y ENFORCEMENT TYPE 1 3 4 5 5 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 © 3 O LJ W G 0 4 <br /> t <br /> k <br /> EXCAVATION STARTED c CASE CLOSED ,tY R H DATE CLOSED <br /> r <br /> RfMEDIAL ACTION TAKEN co CB / ED ET FP GT IT,,, RS HU NA VS <br /> V Primary / Additional RESPONSIBLE PARTY k ! <br /> COMPANY NAME- cy^� {f PHONE- <br /> CONTACT NAME vy ` "v tCl PHONE (46r �J_�I p']1_e3 <br /> ADDRESS <br /> 1 <br /> STATE ZIP <br /> Additional RP's listed on REVERSE SIDE CON AMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />