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PHS/S.. L. COUNTY - ENVIRONMENTAL HEALTH DIVISIOR �. <br /> LOP PROGRAM - MFR INPUT FORM' ! "I <br /> UPDATE Z_ 3 - 91110y `rREVIEWED BY DATE ENTERED1 <br /> ADDITION: EDIT: <br /> ENTERED LOP <br /> SJ/PHS CONTACT 1? I �Q/�/67 <br /> PRIORITY CTP <br /> NOR SENT LOC CODE61 01ST M PROGRAM/ELEMENT CODE DE1 <br /> / ,1? SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 9 39000 SUBSTANCE tI1 A /� <br /> SITE CODE SOURCE OF FUNDS S /O FED EXEMPT Y /( e) PETROLEUM s Y` / N <br /> 1 ,50 q .- <br /> SITE NAME CkIAAL(eS PAY AND N16M' WX Sf14 W DATE REPORTED <br /> ADDRESS T U E� rl�v� S(.r. DATE CONFIRMED <br /> CITYS-rQ c��Q� CA ZIP ;g5zo MULTIPLE RP's Y ! G <br /> SITE STATUS <br /> f <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> t <br /> U G D 12 3 4 5 6 7 $ <br /> RP SEARCH S 1 N R ii DATE UNDERWAY [y J -Cf COMPLETED <br /> PRELIMINARY ASSESSMENT U ,y DATE UNDERWAY r r COMPLETED <br /> REMEDIAL INVESTIGATION U - C i! DATE UNDERWAY CC14PLETED <br /> REMEDIAL ACTION U 1 C' i DATE UNDERWAY COMPLETED <br /> '� u � � COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY i <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 µ5 6 DATE ACTION TAKEN <br /> g: <br /> LUFT CONSIDERATION 1 2 3 N - /5 1 OA R) W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED A Y <br /> REMEDIAL ACTION TAKEN CD CS ED ET FP GT IT RS HU NA VS N7 OT UK <br /> Primary / Additional RESPONSI8LE PARTY <br /> COMPANY NAME CHR P L ES �A A jo -IV,6,1 l-r zn, S�fvi (i PHONE <br /> CONTACT NAME /�J �S _ � �C PHONE y <br /> ADDRESS CJ G�[r <br /> F5 <br /> CITY S OC K l o N a : ... 1 .STATE CA Z!P I <br /> k t CONTAMINATED MFR INFO on REVERSE SIDE <br /> listed on REVERSE SIDE <br /> Additional RP�s <br /> ER 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />