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Ph;.-�AN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH Dk,,--AON <br /> / LOP PROGRAM - MFR INPUT FORM <br /> UPDATE f 1 3 f `F IBY REVIEWED BY DATE ENTERED B <br /> ADDITION• EDIT: <br /> ENTERED LOP SJ/PHS CONTACT [PRIORITY <br /> NOR SENT LOC CODE DIST PROGRAM/ELEMENT CODE —7 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 2 3 <br /> SITE CODE ,,-),5-v, SOURCE OF FUNDS S / F FED EXEMPT r / N PETROLEUM Y / N <br /> SITE NAME DATE REPORTED <br /> ADDRESS ' '1 DATE 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 7 8 <br /> RP SEARCH S I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSKENT 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 KONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTIOC! TAKEN <br /> LUFT CONSIDERATION 1 2 3 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN FCD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> JAN 2 <br /> Primary / Additional RESPONSIBLE PARTY JliIV 4 1994 <br /> COMPANY NAF9E _ J -- � PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS �, O lP <br /> CITY STATE - ZIP a J <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> EH 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />