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PAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIOJN <br /> A' LOP PROGRAM - MFR INPUT FORM / <br /> UPDATE �� 3��z BY ////, REVIEWED BY DATE ENTERED 9 �� BY <br /> !lIYYY •••vvv((( ADDITION: EDIT: W-11 <br /> ENTERED LOP SJ/PHS CONTACT MAUtew PRIORITY Q <br /> NOR SENT LOC CODE D DIST 3 Z O PROGRAM/ELEMENT CODE— Zq <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION !! <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / <br /> SITE NAME �W��• t/r� y �DO Q DATE REPORTED <br /> ADDRESS 67. 1G7-6.e �� �C DATE ON <br /> CITY LL/GGD CA ZTP MULTIPLE RP's Y / <br /> rte- SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S 0D 1 2 3 4 5 7 8 9 �P�3��2 <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 DATE UNDERWAY COMPLETED —5-9z 2.9z <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED / 92 <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 Q�f <br /> EXCAVATION STARTED CASE CLOSED 0 R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN F CD CB ED ET FP GT IT RS HU NA VS <br /> _Primary / _Additional RESPONSIBLE PARTY <br /> COMPANY NAME D %O PHONE <br /> CONTACT NAME /„IQ ChAeZ -s Rbat f PHONE <br /> ADDRESS 0 r O V 9oy6 ---fff��— <br /> a /� <br /> CITY STATE N ZIP 3� —�0�1G <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE v <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />