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PHS/**JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISyy, <br /> LOP PROGRAM -UPDMF <br /> R INPUT FORM <br /> ATE O ` Z BY /AJC REVIEWED BY ' DATE ENTERED r l BY <br /> i <br /> ADDITION• f+ EDIT: <br /> ENTERED PILOT � � SJ/PNS CONTACT /^ �� SWEEPS # D� PRIORITY <br /> NOR SENT LOC CODE 6 DIST z PROGRAM/ELEMENT CODE 3 Z 7Q <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE / SOURCE OF FUNDS S / F FED EXEMPT Y / PETROLEUM / N <br /> - T 01 G <br /> SITE NAME a2r <br /> � DATE REPORTED Z J <br /> ADDRESS Cv` DATE CONFIRMED f/ <br /> a oGG <br /> CITY CA ZIP m/;. MULTIPLE RP's Y / <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 l� <br /> RP SEARCH OS 1 N R DATE UNDERWAY -;// COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATIOk OU <br /> yf- DATE UNDERWAY G COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY G COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N EkFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 0 3 H 0 p 10 W G 0 <br /> --F <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CS ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME � ,/C PHONE ©�CJ',( — <br /> CONTACT NAME PHONE �D G <br /> ADDRESS 7� ni10� <br /> CITY STATE / ZIP �O <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 />