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PHS JOAQUIN COUNTY - ENVIRONMENTAL HEALTH D1VI.,,;�.1 <br /> LOP PROGRAM - MFR INPUT FORM <br /> UPDATE j// -7 147 T BY ��� REVIEWED BY DATE ENTERED BY <br /> -911 <br /> ADDITION• EDIT: Yr <br /> ENTERED LOP f� (L; SJ/PHS CONTACT ]PRIORITY <br /> NOR SENT LOC CODE DIST 001 PROGRAM/ELEMENT CODE 3�0 <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # 39000 SUBSTANCE #1 (z() 2 3 15 <br /> SITE C SOURCE OF FUNDS S / OF <br /> FED EXEMPT Y / PETROLEUA Y / N <br /> SITE NAME DATE REPORTED <br /> ADDRESS <br /> DATE CONFIRMED <br /> ( � r „ ) � <br /> CITY �- v� CA ZIP MULTIPLE RP's Y / N <br /> JJJ SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G 0 1 2 f3 4 5 6 7 /8 <br /> RP SEARCH S I N R DATE UNDERWAY �1 Gj COFIPLETED <br /> PRELIMINARY ASSESSMENT Lu <br /> C DATE UNDERWAY (,� A 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 <br /> COMPLETED <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE //1 / 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION �1 C3-) CCD l/O OW 0 <br /> EXCAVATION STARTED /`Z- , n y CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ( ED FP GT IT RS HU NA VS VE NT OT UK <br /> Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME �• PHONE 17 <br /> CONTACT NAME J PHONE <br /> ADDRESS <br /> CITY STATE CAZIP 3S 2-0 <br /> Additional RPI"- ed 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 />