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Submttal Number 93--245 Dat ¢ ? ceived 03/ 11 / 97, ' <br /> ( Site Code : 1050 f <br /> JSite Name : GRSCO SERVICE STATION Lead Ayency : <br /> Address : 749 E CHARTER W`( Contact : <br />; I City : STOCKTON Zip : 95:'05 Phone : <br /> Billing / responsible Party Information <br /> IBillinq Name : Bill Info OK ? y <br /> I Address : <br /> fffl City : State : Zip : <br /> contact <br /> Phone <br /> Property Owner/ Operator <br /> Name : Phone : <br /> Address : <br />' + City : State : Zip : <br />'Client Information ( if different from Owner / Operator ) <br /> Name : Phone : <br /> Address : <br /> City : State : Zip : <br /> Applicant ' s name , date signed , title <br /> y Name : Date : <br /> I' <br /> Title : <br /> { Consultant Company : CA GEOPHYSICAL GRP , <br /> ++ Contact Name : Phone : <br /> Other. Contact name or Info : Phone : <br /> i <br /> Program Element : 3525 Billing Code : Assiqned To : MC <br /> Title of Submittal : UM REPORT <br /> IL Date of Submittal : 02 / .`-'4 / 93 0-IRequest : N OT Request Date : <br /> +� Type-- e of Submittal : 9 Quarterly Report / Past - Remedial Monitoring <br /> Permit Fee Raid 0 . 00 — — -- <br /> � Check aCash <br /> I Date Paid <br /> I <br /> t_ <br /> �I Permit Fee Paid 0 . 00 <br /> `+ Check No . / Cash <br /> Date Paid I I y <br /> Staff Review Due : OT Scheduled : OT Completed : <br /> I Action Date I Action Date I Action Date <br /> Ack / Com Ur Ne Add . Info R Sr Due <br /> 9 P <br /> Ack / Com Ltr Recd Nevis ' . R gsted ' R Uue <br /> IRWQCR Comments Rep t t . r Comp . P" r Due 1� <br /> Othr Agency Appr File - RP Due lI <br /> Add . Info Recvd Denied Revision Due II <br /> gmit Type : ISpecial Permit Issued : 10th Agency Due II <br /> I or. ., ; oh+ rnmr, r + 11 <br />