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PHS71 <br /> /," JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIS <br /> LOP PROGRAM - MFR INPUT FORM <br /> BY <br /> REVIEWED BY DATE ENTERED GBY / <br /> ADDITION• EDIT• <br /> / SJ/PHS CONTACT � �--�� SWEEPS # �� Z PRIORITY <br /> EENTER:ED:PILOT �/2( ' I 1� <br /> COMP # L/ LOC CODE102— DIST 7 v PROGRAM/ELEMENT CODE 7 •S <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 s7 O� (� 2 5 <br /> SITE CODE / Z SOURCE OF FUNDS S / FED EXEMPT Y / PETROLEUM / N <br /> SITE NAME 1 S �CC DATE REPORTED <br /> ADDRESS 2-612 DATE CONFIRMED <br /> CITY G CA ZIP Z,[� MULTIPLE RP's Y / N <br /> SITE STATUS / <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U r G D 1 2 3) 4 5 7 8 9 <br /> RP SEARCH S� I N R DATE UNDERWAY L/Z // COMPLETED <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY /�1/L71� COMPLETED <br /> REMEDIAL INVESTIGATION U U 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 ENFORCEMENT TYPE 1 2 3 ' 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 3 3 � CC? OA U CO l.:/ <br /> EXCAVATION STARTED N�/ „ CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED (:ETl FP GT IT RS HU NA VS <br /> —Jzprimary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME �t S PHONE <br /> CONTACT NAME S/,Q PHONE �J y S <br /> ADDRESS Z,6> � �� <br /> ZIP <br /> CITY <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11190 89-20(IV)01/90 PILMFA <br />