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-ouomt,r;ai ivumuer lj.;-i2U4 Date Heceived UL-/L-4/93 j <br /> r Site Code: 1464 Site Name: FRANK'S EXXON 0 Lead Agency: <br /> Address: 1399 E YOSEMITE AV Contact: _ <br /> City: MANTECA Zip: 95336 Phone: <br /> Pilling/responsible Party Information ? <br /> iBilling Nage: Pill Info OK? <br />' Address: <br /> City: State: Zip: <br /> Contact: Phone <br /> Property Owner/Operator <br /> Name: phone: i <br /> Address: <br />{ City: State: Zip: <br /> J Client Information of different from Owner/Operator) j <br /> Name: Phone: k <br /> Address: <br /> City: State: Zip. <br /> Applicant' s name, date signed, title <br /> t Name: Date: <br /> Title. <br />[ i <br /> Consultant Company: AEGIS <br /> Contact Name: Phone: <br /> Other Contact name or Info: Phone: <br /> t <br /> Prograr Element: 3506 Pilling Code: `Assigned To: ML <br /> Title of Submittal: QM REPORT <br /> Date of Submittal: 02/11/43 OT Request: N OT' Request Date: t <br /> Rega- <br />' Type of Submittal : 9 Quarterly Report/Post-Remedial ,'Monitoring , <br /> i <br /> Permit Fee Paid 0.00 <br /> Check No. /Cash <br /> t Date Paid <br /> t <br /> li Permit Fee Paid 0.€0 � t <br />} � Check No. /Cash t <br /> 1 � Date Plaid <br /> Staff Review Due: OT Scheduled: 07 Completed: <br /> Action Date Action Date Action Date <br />+ IlAck/Com Ltr Req Add. Info Reqstd Srp Due t E <br /> lAcklCom L Recd Revisi ed _ —PR Due <br /> ! RWQCP Comments Re a omp '1�� Ear Due <br /> lOthr Agency Appr e/ FRDue <br /> it Add. Info Recvd t t R ision Daae <br /> Permit Type: tSpec asec: i Oth Agency Due # t <br /> WrkpIn Revw Camp Comment Ltr Sent Project Comolt �� } <br />