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PNS/SA <br /> JOAQUIN COUNTY - ENVIRONMENTAL HEALTH DIYISI <br /> LOP PROGRAM - 14FR INPUT FORM N <br /> UPDATE Q p BY REVIEWED BY DATE ENTERED BY <br /> �ll� [ <br /> ADDITION• "EDIT• <br /> ENTERED LOP 5J/PHS CONTACT PRIORITY (� <br /> NOR SENT LOC CODE { ` DIST PRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 <br /> SITE CODE Ls 9 SOURCE OF FUNDS S /" F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME DATE REPORTED <br /> te <br /> ADDRESS J DATE CONFIRMED <br /> CITY / 1.CA ZIP Z Z� MULTIPLE RP's Y / <br /> .SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE? <br /> U G D 1 2 3 4 5 7 $ 9 <br /> RP SEARCH I N R DATE UNDERWAY COMPLETED <br /> PRELIMINARY ASSESSMENT U DATE UNDERWAY COMPLETED <br /> REMEDIAL INVESTIGATION U DATE UNDERWAY COMPLETED <br /> REMEDIAL ACTION U 1 CO DATE UNDERWAY COMPLETED <br /> POST REM ACT MONITORING Y ® U C DATE UNDERWAY COMPLETED <br /> ENFORCEMENT ACT TAKEN Y ENFORCEMENT TYPE 1. 2 3 4 •5 6 DATE ACTION TAKEN <br /> LOFT CONSIDERATION 1 2 H S C A R W G 0 <br /> EXCAVATION STARTED CASE CLOSED - R . - H DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB 'ED ET FP GT IT RS, HU 114 YS <br /> Primary / Add.itional RESPONSIBLE PARTY,, <br /> COMPANY NAME PHONE (Co 'e <br /> / <br /> CONTACT NAME , " PHONE r� �l <br /> f <br /> ADDRESS <br /> CITY 1 .STATE ZIP <br /> Additional RP's listed on REVERSE SIDE CONTAMINATED MFR INFO on REVERSE SIDE , 4 <br /> i_ EN 23 083(09/89)REVISED 11/90 $9.20(IV)01/90 PILMFA ° <br /> i <br />