Laserfiche WebLink
PH N JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIV JH <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE BY `,/ j_ REVIEWED BY DATE ENTERED BY <br /> ADDITION• DIT• <br /> ENTERED PILOTT I SJ/PHS CONTACT SWEEPS # ?—Z S �FTPRIORITY <br /> NOR SENT LOC CODE TOIST PROGRAM/ELEMENT CODE J <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # F39000 SUBSTANCE #115 <br /> SITE CODE V, q M/j SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME DATE REPORTED <br /> ADDRESS G DATE CONFIRMED <br /> v <br /> CITY CA I ZIP 155::�,Zor KULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 7 8 9 f <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL 1NVESTIGATIOn U pf, DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTIO3 U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT rMITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPET1 2 3 4 5 6 DATE ACTIM TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATIO3 STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> Primary / ZAdditionat RESPONSIBLE PARTY <br /> COMPANY NAME ¢ �,/ D I PHOAE <br /> -1 'e` ' � J V PHONE <br /> ADDRESS <br /> CITY TdC,& STATE ZIP <br /> Additional 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 />