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PHS / SAN JOAN 4N COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> PI RO RAM - MFR INPUT FORM <br /> UPDATE / / BY DATE ENTERED a / le / W By I <br /> ADDITION : EDIT : DELETE : <br /> j COMP 67/ASCd 74� LOC CODE 01 DIST 5523' PROG / ELEMENT CODE <br /> 23u Q <br /> ENTERED PILOT / / CONT AM MFR FILEDI Y / N PRIORITY <br /> i <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR ¢ 39000 SOURCE OF FUNDS S / F SUBSTANCE <br /> SITE CODE ¢ ` � FED EXEMPT Y / N PETROLEUM Y / N <br /> DATE REPORTED / / DATE CONFIRMED ICATEGORY I S <br /> SITE NAME <br /> ADDRESS <br /> CITY <br /> STATE CA ZIP <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS <br /> EMERGENCY RESPONSE <br /> U / S / G / D 1 2 3 4 5 6 7 8 <br /> RP SEARCH S / I / N / R DATE UNDERWAY / / COMPLETED <br /> PRELIM ASSESSMNT U / C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVEST U / C DATE UNDERWAY / / COMPLETED <br /> REMEDIAL ACTION U / C DATE UNDERWAY / / COMPLETED <br /> DATE EXCAVATION STARTED / / REMEDIAL ACTIONS TAKEN <br /> POST REMEDIAL ACTION MONITORING y / N / U / C <br /> POST REMED ACT MONITOR DATE UNDERWAY COMPLETED <br /> ENFORCE ACT TAKEN Y / N DATE UNDERWAY / / COMPLETED <br /> ENFORCEMENT ACTION TYPE ] / 2 / 3 / 4 / 5 / 6 <br /> CASE CLOSED Y / R / H DATE CASE CLOSED <br /> RESPONSIBLE PARTY <br /> COMPANY NAME b� n,r. r4y 6 x c PHONE / n <br /> CONTACT NAME f. /�/, �„a , I � V <br /> tS✓1/� l>IV PHONE ^ 8� <br /> ADDRESS <br /> CITY <br /> V � <br /> EH 23 083 ( 6 / 89 ) 89 - 20 ( IV ) 5 / 89 PILMFR <br />