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Ph N JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DI\,7N <br /> J LOP PROGRAM - MFR INPUT FORM <br /> AN <br /> UPDATE Z� 3 BY REVIEWED BY DATE ENTERED FL� <br /> ADDITION: EDIT• <br /> ENTERED PILOT SJ/PHS CONTACT SWEEPS 0 PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR D F39000 SUBSTANCE 01 15 <br /> --T <br /> SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE CCD7E //,?g <br /> Q�„ p�,s -r ..C. .�C DATE REPORTED <br /> SITE NAME iC�Y' ( f3 �. <br /> ADDRESS 0-33 �- DATE CONFIRMED <br /> CITY CA ZIP KULTIPLE RP's Y / H <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 7 8 9 <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U vr- DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTI03 U I C DATE UNDERWAY COCIPLETED <br /> POST REM ACT KONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N TENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CO3SIDERATION 1 2 3 H S C A R W G O <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTIO:! TAKEN CO CB ED ET FP GT IT RS HU NA VS <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME & Ltu . PHO.-JE <br /> CONTACT NAME c v� n (A. PHONE <br /> q <br /> ADDRESS <br /> _ Cy <br /> CITY — J JSTATE �A ZIP Cr'Z�Og� S <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 11/90 89-20(IV)01/90 PILMFA <br />