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t <br /> PHS/Skl,.}3AGUIN COUNTY - ENVIRONMENTAL HEALTH 01VIS44 <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE -1 J BY REYIEiIED DATE ENTts'IIEb t;Y <br /> ADDITION• EDIT: <br /> ENTERED PILOT SJ/PHS CONTACT - � SWEEPS S PRIORITY <br /> NOR SENT b CODE �?J DIST 1� ' �PR-OGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 :�-03 4 <br /> SITE CODE Q a SOURCE OF FINDS S / FED EXEMPT Y / l N 7 PETROLEUM © J N <br /> SITE NAMEJ'� ! /� DATE REPORTED <br /> a-7 <br /> ADDRESS lfl �6- 1, `J DATE CONFIRMED <br /> CITY WIA CA I ZIP olaVgl MULTIPLE RP's J NO <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 7 8 9 ` I <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U W, 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 7ENFORCE14ENT TYPE F 1 2 3 4 5 6 DATE MOI TAKEN <br /> LOFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R H0)tCLwrw <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT NA VS <br /> ry / Additional RESPONSIBLE PARTY <br /> COMPANY NAME PHONE <br /> CONTACT NNE V I \ PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EN 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />