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a?- SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIV1SITE MITIGATION/ASSESSMENT SUBMIT# <br />SITE ADDRESS Q LEAD AGENCY <br />AGENCY CONT <br />T <br />CONSULTANT CO <br />PHONE Id/AREA CD <br />CONTACT NAME PHONE <br />OTHER CONTACT NAME or INFO PHONE <br />�r <br />SITE CODE # LL02I <br />PROG/E <br />' LEMENT BILLING CODE ASSIGNED TO <br />TITLE OF SUBMITTAL: <br />DATE RECEIVED 1 5 DATE ON SUBMITTAL OT QUEST OT REQUEST DATE <br />i <br />TYPE OF SUBMITTAL <br />I <br />OWE TYPE OF SUBMITTAL <br />CODE <br />IRE- EXCAVATION WKPLN <br />1 PERMIT APPLICATION w/o WRKPLN <br />10 <br />PERMIT FEE PD <br />CK #/CASH <br />DATE <br />SITE ASSESS WKPLN <br />2 WORKPLAN for PERMIT ACTIVITY <br />11 <br />S <br />RWQCB COMMENTS <br />i <br />ASSESSMENT REPORT <br />3 OTHER WRKPLN w/o PERMIT ACTIVITY <br />16 <br />S <br />OTHER AGENCY APPROVAL <br />( <br />ASSESS RPT w/WKPLN <br />4 OTHER AGENCY REPORT <br />17 <br />S <br />DENIED <br />SPECIAL PERMIT ISSUED <br />REMED ACTION PLN (RAP) <br />5 LETTER <br />18 <br />S <br />ASSESS RPT WRAP <br />b PUBLIC PART INFO <br />19 <br />REVIEW Fi�E PD <br />CK #/CASH <br />DATE <br />FINAL REMED PLN (FRP) <br />8 <br />S <br />QRTLY RPT/POST REMO MONITORING <br />9 <br />$ <br />STAFF REVIEW DUE: ��_ OT SCHEDULED: ��_ OT COMPLETED:.-- <br />ACTION <br />DATE <br />ACTION <br />DATE ACTION <br />DATE <br />ACKNOWLG/COMMTMNT LTR REQSTD <br />INCOMPLETE/ADDTNL INFO REQSTD <br />SRP DUE <br />ACKNOWLG/COMMTMNT LTR RECVD <br />REVISION REQSTD <br />PR DUE <br />RWQCB COMMENTS <br />REPORT REVIEW COMP TE <br />PAR DUE <br />OTHER AGENCY APPROVAL <br />( <br />_FILE/NO <br />ADDENDUM/ADDTNL INFO RECVD <br />DENIED <br />SPECIAL PERMIT ISSUED <br />RE 1SfON DUE <br />OTHER AGENCY DUE DATE <br />PERMIT ISSUED <br />W / B <br />T <br />k3gKPLAN REVIEW COMPLETE <br />COMMENT LTR SENT <br />PROJECT COMPLETE/FINAL BILL <br />EH 29 03 (PLNLOG revised 5/91) <br />