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PHSJ:� JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI-*,J <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE . c( G BY E. REVIEWED BY DATE ENTERED OCT 2 1 1993 Bd- L <br /> ADDITION: EDIT <br /> ENTERED LOP SJ/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE I DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR V 39000 SUBSTANCE #1 2 3 1 Y5 <br /> SITE CODE f l 2 SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEII~1 Y / N <br /> SITE NAME �i r S � DATE REPORTED <br /> ADDRESS d 3 3' SCS ou J DATE CONFIRMED <br /> CITY CA ZIP MULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G 0 1 2 3 4 (9 6 7 8 <br /> RP SEARCH S 1 N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I CDATE UNDERWAY CCIMPLETED <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 6 DATE ACTIOCY TAKEN <br /> LUFT CONSIDERATIO.'J 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED I I 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 PHONE <br /> CONTACT NAMEt Qr, `�^'`�*'" + PHONE Q� ! -��r c)0 <br /> ADDRESS <br /> CITY C 5� �C STATE ZIP <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 />