Laserfiche WebLink
PHSSPot JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI'b1 <br /> C� I "PROGRAM - MFR INPUT FORM <br /> UPDATE jICl Ct3 BY I-M --a- REVIEWI_D BY DATE ENTERED0 10 99 BY <br /> 111 ADDITION• EDIT• <br /> ENTERED Ltg- !� 3 SJ/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE ll� <br /> DIST PROGRAM/ELEMENT CODE SSITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR * 39000 SUBSTANCE *1 � 3 2 3 <br /> SITE CODE 50 SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME DATE REPORTED /� l -"2- <br /> ADDRESS A- DATE CONFIRMED ` 2� <br /> CITY CA 2IPrjs �LFD MULTIPLE RP's Y / �N <br /> SITE STATUS lI <br /> C,ASE��TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U (SE�S ) G D 1 2 3 4 5 6 7 8 f( � ( 3 <br /> RP SEARCH S i N R DATE UNDERWAY 1] g3 COMPLETED <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY l l / COMPLETER ! <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I CDATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 b DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> ✓ Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME x HONE <br /> CONTACT NAME r PHONE <br /> ADDRESS 1 <br /> CITY STATE 2IP <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />