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MH SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> PILOT PROGRAM - MFR IINPUT FORM <br /> LUPDATE r(a S CL D BY REVIEWED BY DATE TEEI]6 <br /> BY S <br /> -( V <br /> ADDITION: EDIT- <br /> - <br /> ENTERED PILOT SJ-PHS CONTACT SWEEPS # PRIORITY <br /> 17 Lt ZZf 2 <br /> COMP # tA' O LOC CODE DIST '�j'�-� PROG/ELEMENT CODE 2�j 4-� <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 0 39000 SOURCE OF FUNDS / F SUBSTANCE <br /> SITE CODE 2�l Z FED EXEMPT Y / fN'` PETROLEUM / N <br /> SITE NAMEu�L�Q ��� <br /> „�v DATE REPORTED <br /> ADDRESS } Y DATE CONFIRMED ,Z ��J <br /> CITY i „ CA 21P C��'Z� CATEGORY / S <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS EMERGENCY RESPONSE <br /> U S V D 1 2 3 4 5 7 8 1 <br /> RP SEARCH S 1 N R DATE UNDERWAY A jL COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY Z ! Q COMPLETED I <br /> C7 <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY 7 COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY _ COMPLETED <br /> POST REM ACT MONITORING Y N U DATE UNDERWAYLM6- COMPLETED C�'�� <br /> 46-- <br /> ENFORCEMENT ACT TAKEN Y ENFORCEMENT TYPE 1 2 3 4 5 G DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R L1 G 0 <br /> EXCAVATION STARTED CASE CLOSE E <br /> Y R H DATE CLOSED I.. . . <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA WS <br /> RESPONSIBLE PARITY <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> EH 23 083(09/89)REVISED 01/90 <br /> 89-20(IV)01/90 PILMFR <br />