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h <br /> 3 <br /> PHSA:" JOASIUIN COUNTY - ENVIRONMENTAL HEALTH DIVI.6-4 7 <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE q BY REVIEWED BY DATE ENTERED �j/ , BY <br /> ADDITION• EDIT: b .vk. <br /> ENTERED LOP SJ/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAIVELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE } 3`l 1 SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEL14 Y / N <br /> SITE NAME r 43 DATE REPORTED <br /> ADDRESS S Q f DATE CONFIRMED <br /> CITY 11 CA ZIP MULTIPLE RP's Y / N <br /> SITE STATUS <br /> i <br /> I <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> i <br /> U S G D 1 2 3 4 5 7 8 9 <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 1 6 DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> Primary / _ Additional RESPONSIBLE PARTY <br /> COMPANY NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE ZIP <br /> . Additional RP's Listed on REVERSE SIDE. CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED .11/90 89-20(]V)01/90 PILMFA <br />