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PHQ JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DI <br /> ce'll�` LOP PROGRAM - MFR INPUT FORM <br /> [UPDATE /}� BY REYIEWEp BY DATE ENTERED BY ,� f <br /> a ADDITION:_ EDIT• t <br /> ENTERED LOPa� 7 SJ/PHS CONTACT /� / PRIORITY <br /> NOR SENT ` LOC CODE �1 D[ST ..�J2�7 - PROGRAM/ELEMENT CODE <br /> -SITE SPECIFIC QUARTERLY REPORT INFORMATION C / <br /> CONTRACTOR # 39000 SUBSTANCE #1 �f <br /> SITE CODE 7 2 / SOURCE OF.FUNDS �; / F- FED.EXEMPT Ym / PETROLEUM. Y / N <br /> SITE NAME DATE REPORTED <br /> D f <br /> ADDRESS O O D� �J DATE CONFIRMED <br /> CITY G Q CA ZIP �D MULTIPLE RP'S Y / I� <br /> SITE STATUS , <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 �3 4 7 8 9 7 Z-7Z <br /> RP SEARCH S I N R DATE UNDERWAY . COMPLETED >cy <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED c-v <br /> REMEDIAL INVESTIGATION U C, DATE UNDERWAY COMPLETED t <br /> REMEDIAL ACTION ,' tl,, . I C DATE UNDERWAY COMPLETED i <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN N TENFORCEMENT'TYPE 2 3 4 5 b DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 l2 ,3 D W G 0 <br /> EXCAVATION STARTED^ CASE CLOSED Y_ R N `' DATE CLOSED " <br /> REMEDIAL ACTION TAKENE. <br /> CD CB ED ET.,. FP GT ITRS HU '" NA Y5 <br /> ,Primary /v Additional RESPONSIBLE PAR Y:'' <br /> COMPANY NAME " PHONED _ <br /> CONTACT NAME / PHONE <br /> ADDRESS <br /> CITY <br /> a <br /> LI!4 <br /> rx, ZIP O <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(IY)01/90 PILMFA <br />