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Pi.-,,AAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D1,---SON <br /> LOP PROGRAM - MFR INPUT FORM ©(�1J c <br /> UPDATE L BY � � REVIEWED BYE I DATE ENTERED mw ® ( BY <br /> V ADDITION• EDIT: <br /> ENTERED LOP 2 2 Q -IT SJ/PHS CONTACT 1u) PRIORITY �d <br /> NOR SENT LOC CODE (f� DIST (� PROGRAM/ELEMENT CODE 3 S 2 <br /> SITE SlPECIIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR 0 39000 SUBSTANCE Ott � � �'l 2 J 63gO1� 3 <br /> SITE CODE /4-,33 SOURCE OF FUNDS F <br /> S / O FED EXEMPT Y / PETROLELIA Y / N <br /> SITE NAME �0 )76-r�0260/1 DATE REPORTED <br /> ADDRESS 4 / q Su MAIN S7 DATE CONFIRMED I I <br /> CITY A4 /V T CC� CA ZIP p�3. MULTIPLE RP's Y / <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U 0 G D 1 3 4 5 6 7 8 <br /> RP SEARCH S I N R DATE UNDERWAY / - 3 -� COMPLETED - <br /> PRELIMINARY ASSESSKENT U C DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U C DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTIN 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 DATE ACTION TAKEN <br /> LUfT COPISIDERATIO?1tCD <br /> 3 S CC A) R W G 0 <br /> EXCAVATION STARTEDCASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAED /ET FP GT IT RS HU NA VS VE NT OT UK <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAMES ( (j R0 Y�r� � PHONE <br /> CONTACT NAME lI E BOY E -T-7 PHONE ��f�— ( 2 Z <br /> ADDRESS P, O L Ox 1 9 Q <br /> CITYS A L DA STATE C/ ' ZIP <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(1V)01/90 PILMFA <br />