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PHS*JOADUIN COUNTY - ENVIRONMENTAL HEALTH DIVI. <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE 17. �'� .5 1 BY REVIEWED BY BY <br /> ADDITION:_ EDIT: <br /> ENORSENT <br /> ELOT / ` U SJ/PHS CONTACT �'�- oc,4p,\ow� , SWEEPS # PRIORITY . <br /> LOC CODED I DIST 3ZI PROGRAM/ELEMENT CODE 234-9 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 gcoG(a i9 5 <br /> SITE CODE 12�'l -12,3 SOURCE OF FUNDS I S / FED EXEMPT I Y / PETROLELM O / VIN/ <br /> DATE REPORTED /s • !Z 0 D <br /> SITE NAME <br /> ADDRESS /1 7oi <br /> DATE CONFIRMED 5 • �L g <br /> CITY `t' V lS CA ZIP q Z�� 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 7 8 9 <br /> RP SEARCH I N R DATE UNDERWAY / 2� .�(� COMPLETED <br /> PRELIMINARY ASSESSMENT C DATE UNDERWAY -7 l4 . 0 g COMPLETED <br /> REMEDIAL INVESTIGATION U yr- DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U I C DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y N U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 <br /> EXCAVATION STARTED CASE CLOSED Y R H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS <br /> ✓Primary / _Additional RESPONSIBLE PARTY <br /> COMPANY NAME I nN 0C � PHONE 4j5 ��.' --7 <br /> CONTACT NAME V PHONE q,2 - <br /> SISK- <br /> ADDRESS C. 1 (v • l.K���OII�IV I-T �`^' `J cel ��O <br /> CITY W�.LN 2 STATE /I 21P C1 L1 6D(Q <br /> Additi mal Rps Listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE V <br /> 89-20(IV)01/90 PILMFA <br /> EH 23 083(09/89)REVISED 11/90 <br />