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UAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D�'ION <br />LOP PROGRAM - MFR INPUT FORM <br />UPDATE Y L* ?— BY —nz— REVIEWED BY DATE ENTERED ., G�1) BY <br />ADDITION:_ EDIT: <br />ENTERED PILOT <br />- <br />SJ/PHS CONTACT - <br />SUBSTANCE <br />#1 <br />SWEEPS # <br />PRIORITY <br />RP SEARCH <br />NOR SENT <br />- <br />CA <br />LOC CODE <br />DIST <br />Y / N <br />PROGRAM/ELEMENT CODE <br />SOURCE OF FUNDS <br />1 <br />SITE SPECIFIC QUARTERLY REPORT INFORMATION <br />CONTRACTOR <br /># <br />39000 <br />SUBSTANCE <br />#1 <br />f_ G' ( ^ <br />.DATE CONFIRMED <br />RP SEARCH <br />CITY <br />� <br />CA <br />5 <br />SITE CODE <br />Y / N <br />013 <br />SOURCE OF FUNDS <br />1 <br />S / F <br />FED EXEMPT <br />Y / N <br />PETROLEUM <br />LY / N <br />SITE NAME�.�i2� <br />y <br />DATE REPORTED <br />EMERGENCY RESPONSE <br />ADDRESS <br />f_ G' ( ^ <br />.DATE CONFIRMED <br />RP SEARCH <br />CITY <br />� <br />CA <br />ZIP <br />MULTIPLE RP's <br />Y / N <br />SITE STATUS <br />CASE TYPE <br />CONTRACT STATUS <br />STATUS CHANGE DATE <br />EMERGENCY RESPONSE <br />U S G D <br />1 2 3 4 5 7 8 9 <br />RP SEARCH <br />S I N R <br />DATE UNDERWAY <br />COMPLETED <br />PRELIMINARY,ASSESSMENT <br />U C <br />DATE UNDERWAY <br />COMPLETED <br />REMEDIAL INVESTIGATION <br />U Kc - <br />DATE UNDERWAY <br />COMPLETED <br />REMEDIAL ACTION <br />U I C <br />DATE UNDERWAY <br />COMPLETED , <br />POST REM ACT MONITORING <br />Y N U C <br />DATE UNDERWAY <br />COMPLETED <br />ENFORCEMENT ,ACT TAKEN <br />Y N <br />ENFORCEMENT TYPE <br />1 2 3 4 5 6 <br />DATE ACTION TAKEN <br />LUFT CONSIDERATION <br />1 2 3 HS C A R W G 0 <br />EXCAVATION STARTED <br />CASE CLOSED <br />Y R H <br />DATECLOSED <br />REMEDIAL ACTION TAKEN - <br />CD CB ED ET FP GT IT RS HU NA VS <br />r'- C� Primary / _Additional RESPONSIBLE PARTY <br />COMPANY NAME <br />[ - <br />PHONE <br />CONTACT NAME <br />� � -�, -- • -._ F� ,t <br />PHONE <br />�`�-0� -i _ <br />ADDRESS <br />11 LI�J Z%I/ N <br />CITY <br />� ,. <br />STATE <br />%.t -F:-' <br />,2IP <br />Additi onaL 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 />