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Smbr;s t,�! Nu-:b--r- 93 JaL a Received 04/09/93 <br /> Ur�iili"1i71f"�i�Mi?r�lMfg!•ii'ihlhlMhihihliJit�'iilir"lplhil�lhlMMMMMM` ''�1h1MMMMh1MQMMMMMMh1MMMMMMMlriMMMMIf1MI �1MMMh1Mh1MM8 <br />-Site Code: 10581c4 U 3 3 <br />.site Masse: INTERSTATE SHELL 3 Lead Agency: 3 <br /> 3 Address: 620 W CHARTER WY 3 Contact: 3 <br /> 3 City: G1UCKTON Zip: 95206 3 Phone: 3 <br /> TMV,l1MMMl1n;h1MP 1Ml7MMMhrr7hlihlMMMMMMMhiMMMMMMMMMMMMMMQMMMMMMMMMMtMMMMMMMMMMMMMMMMMMMMMM) <br /> Killing/responsible Party Information <br /> UMMMMMMMMMMMMMMMMMMMMMMt"1MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMB <br /> jBilling Nane: Bill Info OK? 3 <br /> 3 Address: 3 <br /> 3 City: State: Zip: 3 <br /> 3 Contact : Phone 3 <br /> TMMMMMMMMMMMMMMMMMMMMh1Mh1Mh1MMMMl%1Mh1MMMMMMh1MMMMMMMMMMMMMMMhiMMMMMMMMMMMMMMMMMMMMMM) <br /> Property Owner/Operator <br /> UMMhihi►�1 MMl►1 MMMMMMMMMMMMMMMMMMlf1MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMh1 MMMMMMMMMB <br /> 3 Nare: Phone: 3 <br /> 3 Address: 3 <br /> 3 City: State: Zip: 3 <br /> TMiy'i1h1MMh1MMMMMMMMMMMMMMhiMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMh1MMMMM) <br /> Client Information (if different from Owner/Operator) <br /> UMMMMMMMMMMMMMMl+1MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMB <br /> 3 Na -e: Phone: 3 <br /> 3 Address: 3 <br /> 3 City: State: Zip: 3 <br /> TMMMMMMMMMMMMhiMh;MMMMMMMMMMI�'MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM) <br /> Applicant' s naie, date signed, title <br /> UMMMMMMMMMMMMh;Mh1MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMB <br /> 3 Name: Date: 3 <br /> 3 Title: 3 <br /> TMMMh/MMh1h1MMhlMhiMMMhiMhlMMhIMMMh1MMMMMMMMMMMMMMh1MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM) <br /> ZDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD? <br /> 3 Consultant Company: AEGIS 3 <br /> 3 Contact Name: Phone: 3 <br /> 3 Other Contact name or Info: Phone: 3 <br /> hDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDY <br /> II 1hriii"1h1MMMMhi�,"l1MMMh1MMh1MMMMMMQMMh1MMMMMMMMMMMMMMMMMMMMMMMMQMMMMMMMMMMMMMMMMMMMMMMM; <br /> Program Ele:.ient: 3526 3 Billing Code: 3 Assigned To: LT <br /> HMl Pih,'h1hiMMMh1h1h1MMMh1MMMMMMMMMUMMMMMMMMMMMMMMMMMMMMMMMMMMMDMMMMMMMMMMMMMMMMMMMMPIMM <br /> Title of Subvittal: DM REPORT <br /> IMMfIh/MMMMMMMMMMMMMMMMMMMMMMMMMMMMQMMMMMMMMMMMMMMMQMMMMMMMMMMMMMMMMMMMMMMMMMMMM; <br /> Date of Subr:ittal: 03/30/93 3 OT Request: N 3 OT Request Date: <br /> L <br />: Type of Subr..ittal: 9 Quarterly Report/Post—Remedial Monitoring <br /> L <br />: Per::it Fee Paid 3 0.00 3 3 3 <br />: Check No. /Cash 3 3 3 3 <br />: Date Paid 3 3 3 3 <br /> GDDDDDDDDDDDDDDDDDEDDDDDDDDDDDDDEDDDDDDDDDDDDDDEDDDDDDDDDDDDDDADDDDDDDDDDDDDDDE <br />: Pernit Fee Paid .j 0.00 3 3 <br />: Check No. /Cash 3 3 3 <br /> Date Paid 3 3 3 <br /> HMMMMMMMh1h1MMMMh1MMMOMMMMMMMh1MMMMh10MMMMMMMMMMMMMh10MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMf <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> IMMMMMMMMMMMhhIMMMh1MMMMMMMMQMMMMMMMMMMMMMMMMMMMMMh1MMMQMMMMMMMMMMMMMMMMMMMMMMMMM; <br /> Action Date 3 Action Date 3 Action Date <br /> LMMMMMMMMMMhlhiiMMMMM MMh1MM9 <br />:Ack/Cosa Ltr Req -Add o Reqstd 3sr� Due <br />:Ack/Co:i Ltr Recd ev jon R s ,s PRue <br />:RWQCB Conr.;ents "t q _.: �,}� I�� b7 3 Pa . Due <br /> PP <br />:Othr Agency A r 017 IU! o Cio I .s FOP Due <br />:Add. Info Recvd ✓0enied 3 Revision Due <br />:Pernit Type: ssued: 3 0th Agency Due <br />:Wrkpin Revw Comp -Comment Ltr Sent 3 Project Complt <br /> F1h1MMMMMh1h1MMh1MMMMMh1MMMh1h1MMMOMh1MMMh1Mh1MMMMMMMMMMhiMh1MMMMQMMMMMMMMMMh1MMMMMMMMMMMMMM <br />