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jt6ca. <br /> SAN JOAQUIN Mi .-Y - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HElxr.H DIVISION �+ �^^`9� <br /> SITE MITIGATION SUBMITTAL G R <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY ( I" 1 SUBMITTAL LOG NUMBER <br /> AT SITE 23. SSESS- DHS / RWQCB 22. NVIRON ASSESS 22.48 THER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT _FSS <br /> TO , S <br /> YPE OF SUBMITTAL or / YPE <br /> ESCRIPTION OF SERVICE ✓ ODE <br /> _J DATE RECEIVED / / / / DATE OF SUBMITTAL / G/� IDT REQUESTED ATE OT REQUESTED <br /> ERMIT FEE PD K#/CASH ATE I IREVIEW FEE PD a�,O K#/CASH ATE <br /> STAFF REVIEW DUE _/_/_ OT SCHEDULED _/_/_ OT COMPLETED_/ (_//_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> %CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD DR DUE <br /> WQCB COMMENTS REVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION IRP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED THER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: Per Unit Per Site Each <br /> fill1ingemittance Amount emit Checked <br /> Program Element ase xplanation DatDate 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 minimum <br /> nvironmental Assessment Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> F�L <br /> ate leceipt No. Issuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM12B <br />