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'PHB/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D SIGN <br />PILOT PROGRAM - MFR INPUT FORM <br />UPDATE j BY �ffQ REVIEWED BY DATE ENTERED / /i BY <br />ADDITION:_ EDIT: <br />ENTERED PILOT <br />39000 <br />SJ -PHS CONTACT <br />S <br />SWEEPS Y <br />C a <br />PRIORITY <br />SITE CODE <br />COMP N <br />RESPONSE <br />LOC CODE <br />FED EXEMPT <br />DIST <br />Y / N <br />PROD/ELEMENT CODE <br />Y / N <br />SITE SPECIFIC QUARTERLY REPORT INFORMATION <br />CONTRACTOR S <br />39000 <br />SOURCE OF FUNDS <br />S <br />/ F <br />SUBSTANCE <br />STATUSEMERGENCY <br />SITE CODE <br />ADDRESS <br />RESPONSE <br />U ,S. - G <br />FED EXEMPT <br />STATE <br />Y / N <br />PETROLEUM <br />Y / N <br />9 <br />RP SEARCH <br />S <br />SITE NAME <br />R <br />DATE <br />`i <br />DATE REPORTED <br />ADDRESS <br />�� C ' C <br />I <br />!N <br />7 .0-� <br />DATE <br />DATE CONFIRMED <br />l ? a <br />CITY <br />i <br />I <br />REMEDIAL INVESTIGATION <br />21P <br />4 <br />C <br />DATE <br />CATEGORY <br />R / S <br />SITE STATUS <br />CASE TYPE <br />PHONE <br />CONTACT NAME <br />CONTRACT <br />STATUSEMERGENCY <br />ADDRESS <br />RESPONSE <br />U ,S. - G <br />D <br />STATE <br />1 2 <br />3 <br />4 1�'f 7 8 <br />FF <br />9 <br />RP SEARCH <br />S <br />1 N <br />R <br />DATE <br />UNDERWAY <br />`i <br />COMPLETED <br />PRELIMINARY�ASSESSMENT <br />U <br />7 .0-� <br />DATE <br />UNDERWAY <br />l ? a <br />COMPLETED <br />I <br />REMEDIAL INVESTIGATION <br />�l�U 1 <br />4 <br />C <br />DATE <br />UNDERWAY <br />of <br />°g 7,J"�' <br />COMPLETED <br />COMPLETED <br />REMEDIAL ACTION <br />U <br />1 C <br />DATE <br />UNDERWAY <br />COMPLETED <br />POST REM ACT MONITORING <br />Y N <br />U C <br />DATE <br />UNDERWAY <br />COMPLETED <br />ENFORCEMENT ACT TAKEN <br />Y <br />N <br />ENFORCEMENT TYPE <br />1 <br />2 3 4 <br />5 6 <br />DATE ACTION TAKEN <br />LUFT CONSIDERATION <br />1 2 3 <br />H <br />S <br />C A <br />R W <br />G 0 <br />EXCAVATION STARTED <br />CASE CLOSED <br />Y <br />R H <br />DATE CLOSED <br />REMEDIAL ACTION TAKEN <br />CD <br />CB ED <br />ET <br />FP <br />GT IT <br />RS NU <br />NA <br />VS <br />RESPONSIBLE PARTY <br />COMPANY NAME <br />PHONE <br />CONTACT NAME <br />- <br />PHONE <br />ADDRESS <br />CITY <br />STATE <br />ZIP <br />EH 23 083(09/89)REVISED 01/90 <br />` 89-20(IV)01/90 PILMFR <br />