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PHS/SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISION <br /> LOP MFR SIDE A - ADDITION: EDIT: <br /> UPDATE ^ A BY ^ - REVIEWED BY DATE ENTERED BY <br /> ENTERED LOP SJ/PHS CONTACT ALPHA CODE Ci�, 1 PRIORITY <br /> NOR SENT. LOC CODE FqqSUPR DIST �j PROG/ELEM 25WDR Y / N NPDES Y / N <br /> SITESPECIFICQUARTERLY ,REPORT INFORMATION J <br /> CONTRACTOR # F <br /> 9000 SUBSTANCE 41 2 3 �41 5 <br /> SITE CODE OURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME f'w, �0� 1610 DATE REPORTED <br /> ADDRESS '1 DATE CONFIRMED <br /> CITY W CA ZIP MULTIPLE 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 6 7 8 <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED / / CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN T <br /> CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> SITE AND FILE STATUS <br /> DEPTH TO WATER �O GRADIENT WELLS NEARBY >500 FT >1000 FT >2000 FT TYPE IR DOM PUS <br /> LAST SAMPLING DATE FLAG DATE UAR # PROP65 # <br /> CONTAMINATED SITE MFR - Addition: Edit: DATE <br /> UGT FILE FAILED PT / / SOIL CONT / / GW CONT / / DW CONT Y / N <br /> CONSULT CONTACTRWQCB CONTACT TSC CONTACT <br /> STREET # SITE STREET APN # <br /> PROPERTY OWNER(S) AND ADDITIONAL RP'S NOTED ON SIDE B Y / N <br />