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PH owl JOAQUIN COUNTY ENVIRONMENTAL HEALTI4 DI 44M <br /> LOP PROGRAM - MFR INPUT FORM <br /> `I <br /> }/}AE(}� REVIEWED BY DATE ENTERED B <br /> UPDATE �3t5BY Y U <br /> ADDITION• EDIT: i <br /> ENTERED LOP <br /> SJ/PHS CONTACT + <br /> NOR SENT LOC CODE DIST w:+ PROGRAM/ELEMENT COOS. <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> 2 s <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME Y� DATE REPORTED <br /> ADDRESS L�- V� , `i-�"f V cL� DATE CONFIRMED � <br /> f- "" �►�� Ez:l <br /> P MULTIPLE RP's—r"lY"�:%�( N' <br /> _I <br /> CITY _ <br /> SITE.STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2. 3 4 5 °I' 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 TAKETCD CB ED ET FP GT IT RS HU NA VS �E) NT OT UK <br /> l <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME 0 �-T' Pit <br /> S..tC„`��”`-- n.PHONE' <br /> CONTACT NAME PHONE <br /> ADDRESS .. �,,L` c•- <br /> _ STATE Z �7 f <br /> � n } IP <br /> CITY �L7C�L, - Y - <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 />