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�. ./SAN JOAQUIN COUNTY - ENVIRONMENTAL HEALTH L 31ON <br /> LOP PROGRAM MFR INPUT FORM �gggi <br /> UPDATE / / BY 0r� REVIEWED BY DATE ENTERED <br /> ADDITION: EDIT- <br /> ENTERED LOP �I V O Z `� SJ/PHS CONTACT O�j �4 PRIORITY <br /> NOR SENT LOC CODE DIST V\/� PROGRAM/ELEMENT CODE <br /> SITE SPECIFIC QUARTERLY REPORT INFORMATION <br /> CONTRACTOR # T39000 SUBSTANCE #1 2 3 <br /> SITE CODE /rj Q' SOURCE OF FUNDS S / F FED EXEMPT Y / N PETROLEUM Y / N <br /> SITE NAME / DATE REPORTED <br /> ADDRESS A L't DATE CONFIRMED <br /> CITY / '1 r �� v v 7CAZIP MULTIPLE RP's Y / N <br /> SITE STATUS <br /> CASE TYPE CONTRACT STATUS STATUS CHANGE DATE EMERGENCY RESPONSE <br /> U S G D 1 2 3 4 5 6 7 8 <br /> RP SEARCH S ,l 1 N R DATE UNDERWAY S �$ rr� COMPLETED <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 <br /> ENFORCEMENT ACT TAKEN Y N ENFORCEMENT TYPE 1 2 3 4 5 6 DATE ACTION TAKEN <br /> LUFT CONSIDERATION 1 2 3 O V C A� R W G 0 <br /> EXCAVATION STARTED CASE CLOSED Y R C L DATE CLOSED <br /> REMEDIAL ACTION TAKEN CD CB ED ET FP GT IT RS HU NA VS VE NT OT UK <br /> n Primary / Additional RESPONSIBLE PARTY <br /> COMPANY NAME l ��1 Y\�. � M �C l qC2 I�Jy� PHONE <br /> CONTACT NAME M S G{ t � � , PHONE <br /> ADDRESS <br /> CITY L K STATE ZIP 6�2-1 <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 />