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PHSLL)JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIVI <br /> i <br /> it <br /> LOP PROGRAM - MFR INPUT FORM <br /> i <br /> UPDATE �� ,�j IIIYm vo REVIEWED BY DATE ENTERED ' £�1 8Y <br /> 2 <br /> P,1993 <br /> ADDITION: EDIT: <br /> ENTERED LOP , IP' I� SJ/PHS CONTACT j 7PRIORITY <br /> NOR SENT.- � !� LOC CODE DISTPROGRAM/ELEMENT11 4 CODE C,.7 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> r <br />�. CONTRACTOR * 39000 SUBSTANCE #1 2� � 2 3 <br /> ii <br /> i SITE CODE �GJC� SOURCE OF FUNDS S / F FED EXEMPTq' Y PETROLEUM Y / N <br /> I <br /> SITE NAME IlKDATE REPORTED <br /> 1431 <br /> ADDRESSA r o n nC � P CcLV C [ � "� DATE CONFIRMED / v? <br />` CITY � �(-� 4 CA IZIP Cl� � MULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE JCONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> � /� 't <br /> U !S } G D 1 2 ( 3 ) 4 5 6 7 �i8 - .9 <br /> L3 it <br /> +�1 <br /> RP SEARCH I N R 3 DATE UNDERWAY '� I -� COMPLETED _ <br /> PRELIMINARY ASSESSMENT 0 c GATE UNDERWAY 7 1s_ �3 COMPLETED t <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY J COMPLETED <br />` REMEDIAL ACTION U I C DATE UNDERWAY :p j} COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY N COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N O ENFORjk CEMENT TYPE 1 _ 2 3 � 4 S b DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 3 H S Q R Wi G 0 <br /> i III ! Z <br /> 11 ,i <br /> EXCAVATION STARTED CASE 1 CLOSED Y R C i L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD C8 ED ETA FP GT IT RS HU NA YS VE NT OT UK Ik <br /> Primary / Additional RESPONSIBLE PARTY <br /> { <br /> COMPANY NAME Ct O 5 I VPHONE <br /> CONTACT NAME p h - ! PHONE qC f q <br /> ADDRESS LZGJ [� lJ` 1 <br /> i <br /> C <br /> CITY STATE <br /> q 520 Z I� <br /> � �( 21P <br /> Additional RP's listed on REVERSE SIDE f CONTAMINATED MFR INFO on REVERSE SIDE f <br /> EN 23 083(09/89)REVISED 8/92 M 89-20(IV)01/90 PILMFA <br />