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PHS/INJOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI S� <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE 1�� 3 BY �� REVIEWED BY DATE ENTERED AUG' Q V 1993 BY <br /> ADDITION:_ <br /> ENTERED LOP J/PHS CONTACT Y I �-1- Qj PRIORITY <br /> No <br /> SENT E-. DIST I��Li 1111 PROGRAM/ELEMENT <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 399000 SUBSTANCE #1 2 3 <br /> SITE CODE ✓n/v 3 I SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEIM Y / N <br /> SITE NAME DATE REPORTED <br /> ADDRESS O '1 c I is o DATE CONFIRMED <br /> CITY d ✓ CA ZIP Olt-t- S/ MULTIPLE RP's n / N <br /> Ainc <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 ASSESSMENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACT10N U I CDATE 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 C 0 <br /> EXCAVATION STARTED CASE CLOSED Y R L L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> Primary / _Additions( RESPONSIBLE PARTY <br /> O V� PHONE <br /> CONTACT NAME O e yJ PHONE W <br /> ADDRESS <br /> 31� <br /> Al <br /> ✓ S . <br /> 9 9 U�• (�' V J� D� /� <br /> CITY Al STATE /' j.ZIP <br /> Additions RP's Listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE <br /> 89-20(IV)01/90 PILMFA <br /> EH 23 083(09189)REVISED 8/92 <br />