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PHSA-,/JOAOUIN COUNTY - ENVIRONMENTAL HEALTH DIV1S, m <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE ���/ BY REVIEWED BY DATE ENTERED f,S 2 199 g <br /> Y t.1. _ ff <br /> ADDITION• EDIT: <br /> ENTERED LOP SJ/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 2 3 <br /> SITE CODE 10(o SOURCE OF FUNDS S / F FED EXEMPT Fy <br /> / N PETROLELr4 Y / N <br /> SITE NAME P n ' `\1 DATE REPORTED <br /> ADDRESS DATE CONFIRMED <br /> CITY CA ZIP (04- MULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U (C) G D 1 2 3 4 5 6 7 <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT i3 � DATE=LUDERWAY =PLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED �T <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 Cmc-QED � 7 C L DATE CLOSED ` t <br /> REMEDIAL ACTION TAKEN CD CS ED ET FP GT IT RS HU NA VS VE NT OT UK <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 <br /> EH 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />