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PHSko� JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV'',`' tl. <br /> LOP PROGRAM - MFR INPUT FORM f Y <br /> UPDATE ] G BY ERVIEWED 8Y' DATE ENTERED BY <br /> ADDITION• EDIT: <br /> ENTERED PILOT SJ/PHS .CONTACT x SWEEPS'# PRIORITY <br /> NOR SENT LOC CODE DIST. PROGRAM/ELEMENT CODE 2� <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE 91 V5 <br /> SITE CODE [ SOURCE OF FUNDS S;, ' / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE [TAME pM o b i 1 $J ti4Z Pt n DATE REPORTEDN a <br /> ADDRESS 5 0 0 G,, h �~ DATE CONFIRMED-. <br /> CITY r�G CA" ZITP 5 2 MULTIPLE RP's Y / H <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS` . _ - STATUS CHANGE DATE. EMERGENCY RESPONSE <br /> U S G D 1 2' 3 4 5 T /11 9 <br /> RP SEARCH S 1. N R DATE UNDERWAY COMPLETED <br /> -.,..- <br /> PRELIMINARY ASSESSMENT U C TDATE-UNDERWAY COMPLETED <br /> REMEDIAL IHVESTTGATION U a DATE UNDERWAY A. - .�` m COMPLETED <br /> 2 h <br /> REMEDIAL ACTION U _I C, DATE UNDERWAY .:- .COMPLETED <br /> POST REM ACT MONITORING Y N ,.., U . C DATE-UNDERWAY 4 COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N :. ENFORCEMENT TYPE 1 _ ,. 42 3 4 5. 6 x 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 ,w .GT IT RS Nu NA VS <br /> n�, Primary / . Additional:RESPONSIBLE PARTY <br /> Ci <br /> bi1 �n 7 <br /> COMPANY NAME,; p v� V r _ .... PHONE Sig) �5 3 -Z� f 4 <br /> CONTACT NAME LQ�Jyr' 4� 4 PHONE <br /> SAO <br /> ADDRESS (J�Z <br /> CITY L�.�r�,l �L ' STATE ZIP 5a 6 — ✓3 <br /> Additional RP's fisted on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SI DE ' <br /> EN 23 083(09/89)REVISED 11/90- 89-20(IV)01/90 PILMFA. <br />