Laserfiche WebLink
P.`,AN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DI,;tON <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE ' G� 3 BY L_: REVIEWED BY DATE ENTERED I`� BY <br /> i ADDITION• EDIT: <br /> ENTERED PILOT I ` 3 SJ/PHS CONTACT - SWEEPS # 16 -71 PRIORITY <br /> NOR SENT O LOC CODE Fo I DIST � 6 1 PROGRAM/ELEMENT CODE 7 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000^ SUBSTANCE #1 �� 4*5 <br /> SITE CODE I 1 SOURCE OF FUNDS S / F FED EXEMPT Y / © PETROLELLA oy <br /> / N <br /> SITE NAME DATE REPORTED -LO/ /7 <br /> ADDRESS `/ /� a P DATE CONFIRMED �vv <br /> CITY V CA ZIP19 IS-20,C1KULTIPLE RP's Y / I! <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 4 5 7 8 9 -5 1 <br /> RP SEARCH S I N R DATE UNDERWAY a (t�/ C(XiPLETED Z S -3 <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY tq ) CCMPLETED <br /> REMEDIAL INVESTIGATION U DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MIITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE L1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT COCJSIDERATION 1 3 © R W G 0 /O <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED f <br /> REMEDIAL ACTION TAKEN co CB ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME PHONE <br /> CONTACT NAME +n PHONE <br /> ADDRESS q <br /> CITY STATE - ZIP (C 0 S <br /> Additionat RP's 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 />