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1 _ _ li <br /> Submttal Number 93 -247 Dais rceived 3 / 11 , 93 %� • <br /> ; Site Code : 10160 y <br /> Site Name : CASCO SERVICE STATION Lead Agency : ; <br /> Address : 749 E CHARTER WY Contact : <br /> 1 City : SI' OCKTON Zip : 95206 phone : 4 <br /> Pilling / responsible party Information <br /> Pilling Name : Pill Info OK ? <br /> Address : <br /> City . State : Zip : ` <br /> Contact : Phone <br /> I <br /> Property Owner / Operator <br /> Name : Phone : 1 <br /> Address : { <br />' I City : State : Zip : <br /> Client Information ( if different from Owner /Operator ) <br /> Name : Phone : <br /> Address : y <br /> City : State : Zip : , <br /> i <br /> Applicant ' s name , date signed , title <br /> Name : Date : <br /> Title : ' <br /> I <br /> I <br /> I Consultant Company : CA GEOPHYSICAL ORP ; <br /> Contact Flame : phone : <br /> Other Contact name or Info : _ phone : <br /> Program Element : 3526 Pilling_ Code : Rssigned To : NC <br /> Title of Submittal : WORKPLAN FOR ADDN SITE ASST <br /> Date of Submittal : 12 / 11 / 92 FOT Request : N OT Request Date : <br /> 1tType of Submittal : 11 Work Plan for Permit Activity <br /> 11 Hermit Fee Paidh <br /> itCheck No . / Cas <br /> Date paid <br /> I� Permit Fee paid OX00 �5 <br /> Check No . / (.ash <br /> I; Date F'aid <br /> Staff Review Due : 01- Scheduled : OT Completed : <br /> Action i Date Action `llate Action Date <br /> � Ac� k / Cam Ltr Req Add . Inf es ': rp Due it <br /> ?Ack / Com Ltr Recd Revisi �� Z P i.le h <br /> +'; ttW(.CP Comments RRe�ep��oyy LoI] p JG Q $ f-' Due {1 <br /> 10'thr Agency Appr Fi eel No Action ` ° RP Due 11 <br /> IIAdd . Info Recvd Denie Revision Due 6 <br /> permit Type : Special Permit Issued : 0th Agency Due 11 <br /> Illdll lja11n Gnow 11 <br />