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PW_ AN d0AQUIN COUNTY - ENVIRONMENTAL HEALTH DIQON . <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE BY.;. :L REVIEWED BY p DATE ENTERED � � BY. <br /> 3: 23. Z_. . <br /> ADDITION; EDIT: <br /> ENTERED LOP S3/PHS CONTACT PRIORITY <br /> NOR SENT LOC CODE DIST - PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION €j <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE0 SOURCE OF FUNDS S /, F FED EXEMPT Y :' / N PETROLEUM Y / N <br /> SITE NAME � GL�-�G �k DATE REPORTED <br /> ADDRESS �� N � ?����� DATE CONFIRMED <br /> 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 T 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 s 2 3 :4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 , H S C A R Wi4 G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R p H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD Co. 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 f STATE ZIP <br /> E{ <br /> [:AdditionaL RPrs listed on REVERSE SIDE ,,;: , � , ,�CONTAMINATED`MFRF.INFO-on-'REVERSE'SIDE. <br /> EH 23 083(09/89)REVISED 11/90 .1 89-20(IV)01/90 PILMFA� <br />