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PHS/SAA1 AQUIN COUNTY - ENVIRONMENTAL HEALTH DIVISIOyJ <br /> LOP PROGRAM - MFR INPUT FORM aay9 <br /> UPDATE I� BY `m� REVIEWED BY DATE ENTERED d U 1 1993 BY <br /> L 1 ADDITION• EDIT- <br /> ENTERED LOP SJ/PHS CONTACT PRIORITY <br /> NOR SENTLOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE � 3 SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME c �-- DATE REPORTED <br /> ADDRESS cy V GATE CONFIRMED <br /> CITY �-� CA ZIP MULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 6 T 8 <br /> RP SEARCH S i N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U <br /> C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U C <br /> DATE UNDERWAY COMPLETED <br /> U I C' DATE UNDERWAY COMPLETED i 93 <br /> REMEDIAL ACTION 1-3 <br /> � <br /> POST REM ACT MONITORING Y N U C <br /> DATE UNDERWAY COMPLETED L! �� -3 <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 <br /> EXCAVATION STARTED <br /> CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT 1T RS HU NA VS VE NT OT UK <br /> Primary / Additional RESPONSIBLE PARTY <br /> PHONE <br /> PADDRESS <br /> PHONE <br /> L.......... 7TE ZIP <br /> EY <br /> Additional RP�slistedon REVERSE SIDE <br /> CONTAMINATED MFR INFO on REVERSE SIDE <br /> 89-20(IV)01/90 PILMFA <br /> EH 23 083(09/89)REVISED 8/92 <br />