Laserfiche WebLink
PHsp� JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS, <br /> LOP PROGRAM - MFR INPUT FORM �✓ <br /> r <br /> UPDATE `3 CBY L tzp_V <br /> IEWED BY DATE ENTERED ► BY <br /> 1 1 ADDITION: EDIT: <br /> ENTERED PILOT �� t SJ/PHS CONTACT u SWEEPS #E �j ,f�j� PRIORITY <br /> NOR SENT, Y LOC CODE ® ( DIST f� PROGRAM/ELEMENT CODE ('`7 J � � <br /> E <br /> SIT E.SPECIFIC QUARTERLY REPORT INFORMATION 1 <br /> 1 - - <br /> CONTRACTOR # t39000 SUBSTANCE #1 5 <br /> vie rr�- <br /> --T <br /> SITE CODE 4 ,+i SOURCE OF FUNDS S / FED EXEMPT Y / w *:. PETROLEUM / =N <br /> r s. <br /> SITE NAME L4 <br /> DATE REPORTED Z� <br /> ADDRESS DATE'CONFIRMED f O <br /> CITY �, Y CA- ZIPa MULTIPLE RP's Y `/ l N' <br /> 3 t SITE'STATUS y_ --- <br /> } 3 <br /> CASE TYPE _ y CONTRACT STATUS' STATUS CHANGE DATE EMERGENCY'RESPONSE <br /> U G D 1 2- _.•� " "4 5 -7- `8 9- <br /> RP SEARCH �ST [ !'N ' R>' DATE UNDERWAY �(J = ( COMPLETED f� <br /> I <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY _ COMPLETED- - - <br /> REMEDIAL INVESTIGATION U - C l ., 'DATE-UNDERWAY COMPLETED ` <br /> REMEDiAL•ACT ION U I C DATE UNDERWAY ' COMPLETED` - <br /> POST REM ACT MONITORING Y N U`'- "C" DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N 7ENFOR6EMIiNT 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 H :" DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD ' CB ED ET' FP GT IT RS HU NAI VS <br /> r <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME ` f� PHONE <br /> CONTACT NAME ' ' ` ' 'PHONE"- <br /> ADDRESS p�.5 r <br /> CITY � 1 STATE ".�� ZIP--.' s.5 <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 />