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SAN JOAQUIN OTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL *H DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY �/ 7 SUBMITTAL LOG NUMBER <br /> GT SITE 23._LESS- DHS / RWOCB 22. NVIRON ASSESS 22.48 TNER (PROG/ELEMENT _ _ PILOT PROGRAM <br /> WEEPS #/SITE CODE # COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT SSIGNED TO <br /> YPE <br /> YPE OF SUBMITTAL or / <br /> ODE <br /> ESCRIPTION OF SERVICE <br /> DATE RECEIVED 3 / / DATE OF SUBMITTAL Z /L7�/� T REQUESTED ATE OT REQUESTED / / <br /> ERMIT FEE PD �, K#/CASH2�1ATE - EVIEW FEE PD / K#/CASH o 7(fj,� ATE 7 q q <br /> STAFF REVIEW DUE /_/_/_ OT SCHEDULED _/_/_ OT COMPLETED—/—/— <br /> ACTION <br /> 7 <br /> ACTION DATE ACTION DATE ACTION DATE <br /> LKNOWLG/CGMMTMNT LTR REOSTD INCOMPLETE/ADDTNL INFO REOSTD 3RP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REOSTD IR DUE <br /> WOCB COMMENTS EVIEW COMPLET PAR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION RP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED / SPECIAL PERMIT ISSUED 3THER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT BILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site _Each <br /> filling emittance Amount emit Checked <br /> Program Element ase xptana tion Date Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight <br /> State/Federal Authorized) 53.00/hr 5 hour minimum <br /> azardous Material Transmission <br /> ipeline Assessment Oversight 53.00/hr 5 hour mini" <br /> nvirormental Assessment Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour mini mm <br /> ther Government Oversight Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By Date Receipt No. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />