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P"AN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIrd1ON ^ <br /> LOP PROGRAM MFR INPUT FORM G1 <br /> UPDATE I,.oj2jqf BY REVIEWED BY DATE ENTERED BY <br /> ADDITION: __%�-�DIT: <br /> ENTERED LOP j SJ/PHS CONTACT v- �• PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 11 39000 SUBSTANCE #1 <br /> SITE CODE '�- SOURCE OF FUNDS S / FED EXEMPT Y / PETROLEUM / N <br /> SITE NAME cs cCA, RZ ck"-S DATE REPORTED <br /> ADDRESS �Ot � --YYl c, 4,e, DATE CONFIRMED <br /> CITY CA ZIP MULTIPLE RP's Y / <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U3 G D 1 2 3 4 5 7 11 9 <br /> RP SEARCH S I N R DATE UNDERWAY 101-7b COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY �Ic> 7 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 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R \W G <br /> EXCAVATION STARTED CASE CLOSED 'Y` ~ R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT 1T RS HU NA VS <br /> c- Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME �� is / ���.� �/; ('AU/� PHONE <br /> CONTACT NAME ( �JY1 PHONE <br /> ADDRESS ` <br /> STATE ZIP 04CITY <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> Axa nraar.rtQeno�A�curc�cn. 111 ron 89-20(1V)01/90 PILMFA <br />