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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS104 ! <br /> PILOT PROGRAM - MFR INPUT FORM / <br /> UPDATEp BY ['did tib�e REVIEWED BY s . <br /> emDATE ENTERED ! BY <br /> _ .:,�-_:_f_!�- <br /> f <br /> ADDITION: EDIT: 4~ , <br /> ENTERED PILOT C SJ-PHS CONTACT SWEEPS # PRIORITY <br /> COMP # �A LOC CODE Q 9 DIST Z-7- PROG/€LEMENT CODE 23 <br /> SITE <br /> II SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SOURCE OF FUNDS S / F SUBSTANCE XZ20 <br /> SITE CODE ��� FED EXEMPT Y / N, PETROLEUM / N <br /> y <br /> SITE NAME DATE REPORTED 7/ 1eTG <br /> DATE CONFIRMED <br /> ADDRESS � �f i9 / <br /> CITY S'� IJ CA ZIP �`S'Z�S CATEGORY R� / S <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 7 8 9 <br /> RP SEARCH S I N R DATE UNDERWAY A/1 <br /> !� COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY � ` U COMPLETED " v <br /> / f <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> I <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br />- I <br /> f <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED 5 <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 2 3 H S C LA7RI W G 0 <br /> EXCAVATION STARTED r ? 1�O CASE CLOSED c R N DATE CLOSED <br /> 1 <br /> REMEDIAL ACTION TAKENCD CB ED ET FP GT IT RS HU NA VS <br /> 1 <br /> RESPONSIBLE PARTY <br /> COMPANY NAME �-,, D <br /> Slat co PHONE <br /> CONTACT NAME q PHONE_ <br /> ADDRESS64 <br /> /`1 <br /> wd <br /> CITY STATE <br /> EH 23 083(09/89)REVISEO 01/90 <br /> 89-20(IV)01/90 PILMFR <br />