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PHS,'*../JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVIa,,,( <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE ZI G y- BY sS REVIEWED BY DATE ENTERED BY <br /> ( / <br /> ADDITION: EDIT- <br /> ENTERED LOP (!r z/ SJ/PHS CONTACT <br /> Sy¢SSDJ PRIOR <br /> NOR SENT // �7 LOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR X 39000 SUBSTANCE F1 I z 0 3 2 <br /> SITE CODE SOURCE OF FUNDS S / // F/ FED EXEMPT Y / � PETROLEUM � / N <br /> SITE NAME ll;1 z / �U� r, C /SI S DATE REPORTED g- <br /> ADDRESS — I�f/C ILWWU (( V DATE CONFIRMED o G /� <br /> CITYV0, {'�( vfl�,, CA ZIP �j�le. MULTIPLE RP's Y <br /> ((V//111��� lll✓ 1 SITE STATUS <br /> CASE TYPE CON RACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U G D 4 5 6 7 8 <br /> RP SEARCH 1 N DATE UNDERWAY /. I CCMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY lJ�'Z� L y COMPLETED / <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY I COMPLETED <br /> REMEDIAL ACTION U I CDATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 Q 3 © @ W G 0 /C <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED <br /> REMEAygflTAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT T UK <br /> *kNY / Primary / Additional RESPON�Sj,§LE PeRTr6UN 2 <br /> NAME /' _ / / _ r PHONE qq'' <br /> CONTACT NAME PHONE D <br /> ADDRESS n ! n a <br /> CITY J STATE C� ZIP Tqs�d <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 />