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Submttal Number 9 ' . - 475 —Date Received 05 / 28 / 93 <br /> Site Code : 1060 <br /> Site Name : GASCO SERVICE STATION Lead ye: ney : <br /> I y Address : 749 E CHARTER WY Contact : y <br /> y City STOCKTON Zip : 95206 111 Phone : <br /> Pillring / rerl.:tons :ih :le r 'arty Information <br /> I1Billing Name : Pill Info OK ? y <br /> II Address : y <br /> II City : State : Zip : y <br /> f Contact : phone y <br /> Property Owner / Operator <br /> Name : phone : y <br /> } Address : y <br /> City : Staten Zip : <br /> Client Information ( if diff= erent from Owner / Operator ) <br /> ........._ . . .. __ . _.—.._ � _._ � .� ._— —..__.. <br /> IVame , __.: ._._ _.__—_ ..__.___ Phone : i <br /> F Address : <br /> City : State : Zip : I <br /> ApI.A. icant " s name , data signed , ti 1, le <br /> Name : Date : <br /> Title : I <br /> '....._............... . -... _ --Consultant Cam an CA GEOPHYICAL GROUP <br /> I p= y ° S <br /> I Contract Name : Phone : y <br /> Other Contact name or Info : Phone : 1 <br /> L_...__... ._....__.....__.--_.............. <br /> . ._____...—..__.._.—V.__.._.---'------�_--._..__._—...—� <br /> program Element ., 3526 Billing Code : y Assigned To : JAC <br /> It--_.._...—..__.__....._._......._................... <br /> _...-'-_..__."--- -I- -"--_�.—_ <br /> Title of Submittal . ONR <br /> ii Date of Submittal : <br /> 0 ; / ILIE:1 / 93Uf Request : N Ct"f Request Date : <br /> {{ "Cype of SI_tkmitta :t : 9 Gucarter :ly Report / Post - Reined :ill Monitoring y1 <br /> 4 Permit 1-: ee Paid (t , 110 <br /> Check No . / C, y y } <br /> ill Date Paid <br /> t1 2t <br /> Permit Fee Paid ti 0400 <br /> �y <br /> It Check No . / Gash 4 I yt <br /> +I Daae F' aid I I <br /> _ ..... <br /> Staff Review Due : UT Scheduled : OT Completede <br /> t; i} rsi <br /> I Ar._ a on _—.. t e .._. tl <br /> .._'_.._.. c.�„ ..( Y.. — ......._..- ..----.........Date 1 Action --_ ._...--..._ .-- <br /> �I — I 1 Dat a> <br /> �I � q _ - 1 .� Sr._....Dueit <br /> ..__-.____..._—_..__...__......._..__....-...__.,..31 <br /> IIAck / Com L_tr Re Add . Inf p <br /> IAck / C om L. tr Recd Ra= ve sio 77 q IM, PR Due It <br /> IIRWQC:B Comments � Repor / lx F' ar Due <br /> Othr Agency Appr File On FRP Due <br /> Add . Info Recvd Denied Revision Due <br /> It Permit Type Special Permit Issued Oth Agency Due <br /> PWrkpin Revw Comp SComment L.ty, 'went � Project Complt �it <br /> Imo. _ _� , ., _ _._S_. . . _ _ .,. ...... ---_ . . _..._ <br />