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PHS/�,.,JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS,,, d <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE to 5'jam BY REVIEWED BY DATE ENTERED <br /> ADDITION: EDIT• ✓ r ` <br /> ENTERED PILOT SJ/PHS CONTACT �•� �� SWEEPS # 7 A.� PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE slaa 29. 5?j <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE ill I /Z 3 - <br /> SITE CODE % SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME J , , (`� DATE REPORTED <br /> ADDRESS 1,� 1 I/fXJ DATE CONFIRMED <br /> CITY , N ICA I ZIP I 9 6 2� MULTIPLE RP's Y / <br /> -1 <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 C4'-:) 5 7 8 9 <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U vc, 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 11ENFORCEMENT 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 R H DATE CLOSED /7( • �p <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> Additional RP's Listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE T--] <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />