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PHS).:; JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI%_---i <br /> LOP PROGRAM - MFR INPUT FORM s[10 X99 <br /> V E <br /> UPDATE �LI�(4 BY ��� REVIEWED BY DATE ENTERED 12 Byw/� <br /> ADDITION• EDIT• <br /> ENTERED LOP SJ/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 0 39000 SUBSTANCE #1 2 3 <br /> SITE CODE �3 37=RCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME � ,� mak- Gt--V-- DATE REPORTED <br /> ADDRESS ( Q GATE CONFIRMED <br /> CITY cJ�/�/\ CA ZIP MULTIPLE RP's Y / N <br /> V SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 6 7 8 a7:3 1 <br /> RP SEARCH S 1 N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATI0N U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REN ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED ny <br /> R C L DATE CLOSED <br /> REMEDIAL ACTI0N TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <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 8/92 89-20(IV)01/90 PILMFA <br />