Laserfiche WebLink
PHS/S4wodOAQIIIN COUNTY - ENVIRONMENTAL HEALTH DIVIS,,.., <br /> LOP PROGRAM - MfR INPUT FORM <br /> UPDATE G� BY REVIEWED BY DATE ENTERED <br /> ADDITION: EDIT: <br /> ENTERED PILOT SJ/PHS CONTACT / SWEEPS PRIORITY <br /> NOR SENT LOC CODE DIST V PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 39000 SUBSTANCE 01 <br /> SITE CODE ( SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME nul, <br /> �— Z� DATE REPORTED <br /> ADDRESS Q--2- DATE CONFIRMED <br /> CITY �{—� 0 1 ` CA ZIP �{�y�� MULTIPLE RP's Y / N <br /> QD[OJ CCJ/ SITE STATUS w <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 7 8 9 <br /> RP SEARCH I S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U yfl DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPET1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> -T- <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS /J HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY 1 3 <br /> i COMPANY NAME ( PHONE <br /> ,a( <br /> CONTACT NAME W PHONE <br /> �1 VVI` � <br /> ADDRESS go 6 j �2- <br /> d CITY STATE 614 ZIP C� <br /> Additional 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 />