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PHS .'JOAQUIN COUNTY - ENVIRONMENTAL HEALTH Dlv'*.A APR 2 5 1994 <br /> LOP PROGRM - MFR INPUT FORM <br /> UPDATE C I a q <br /> jq3 <br /> �CJ_BY �yl� REVIEWED BY DATE ENTERED Nov 3 0 9 BY <br /> i — ADDITION• EDIT• *d 6 <br /> ENTERED LOP f? a� SJ/PHS CONTACT '' � PRIORITY <br /> NOR SENT 11 <br /> LOC CODE 3 DIS" .. D- PROGRAM/ELEMENT CODE 35 7 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION f <br /> CONTRACTOR # 39000 SUBSTANCE #1 2 3 V5 .a <br /> SITE CODE S g a SOURCE OF FUNDS S / FED EXEMPT Y / PETROLEUM U /. N <br /> SITE NAME fl DATE REPORTED 30 3 <br /> ADDRESS �, f ate DATE CONFIRMED -7 �� (p 193 <br /> CITY CA 21P 9 S'3 7/_ MULTIPLE RP's / N <br /> SITE STATUS 1 1� <br /> CASE TYPE �, CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U � G D 1 ! 2 1 4 5 6 7 8 <br /> RP SEARCHT S I N R DATE UNDERWAY �� 93 CC14PLETED <br /> a <br /> PRELIMINARY ASSESSMENT 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 MONITORING �Y� N U C DATE UNDERWAY COMPLETED r <br /> ENFORCEMENT ACT TAKEN ( Y ) N ENFORCEMENT TYPE 2 3 4 5 G DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 n), <br /> 000 R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTIN TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> Primary / Additional RESPONSIBLE PARTY g NOV 3 0 679 <br /> COMPANY NAME x PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY V STATE ZIP Fss <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 />