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PA.AN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIV,_ON <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE BY REVIEWED BY DATE ENTERED L ,-E BY <br /> I <br /> ADDITION:_ EDIT• <br /> ENTERED LOP L� Z p SJ/PHS CONTACT PRIORITY <br /> MDR SENT /o- q LOC CODE DIST PROGRAM/ELEMENT COD 3s� <br /> ! !! SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR * 39000 SUBSTANCE 01 2 jlle�o 3 3 <br /> SITE CODE J SOURCE OF FUNDS S / if FED EXEMPT Y / PETROLEUM / N <br /> SITE NAME DATE REPORTED <br /> ADDRESS DATE CONFIRMED S/ Z IM <br /> CITY CA Fz_,p],eW76 <br /> MULTIPLE RP's Y / <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 4 5 6 7 8 <br /> RP SEARCH �S I N R DATE UNDERWAY z J�L COMPLETED <br /> PRELIMINARY ASSESSMENT n C DATE UNDERWAY Z 3 / CC04PLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY r COMPLETED <br /> REMEDIAL ACTION 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 2 3 4 5 6 FDATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 3 ® W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED I 6 <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> ,/Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME Q c_Du n (�{f, m - 6 n PHONE <br /> CONTACT NAME C/i •`3 PHONE <br /> ADDRESS <br /> CITY STATE C� ZIP 19S-37(l <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE 7�7 <br /> EH 23 083(09/89)REVISED 8/92 89-20(IV)01/90 PILMFA <br />