Laserfiche WebLink
SAN JOAQUINW64M• PUBLIC HEALTH SERVICES/ENVIRONMENTAL AlCN DIVIS <br /> NON-LOP SITE MITIGATION/ASSESSMENT SUBMITTAL LOG � - <br /> mi <br /> SITE ADDRESS LEAD AGENCY <br /> SITE CODE B PROG/ELEMENT 2 . BILLING CGDE ASSIGNED TO <br /> 007 <br /> TITLE OF SUBMITTAL, J,�/ ��� TYPE SSE Q� <br /> DATE RECEIVED G111hl DATE ON SUBMITTAL OT REQUEST OT REQUEST DATE <br /> PERMIT FEE PD CK #/m DATE REVIEW FEE PD CIC d/CASH DATE ]STAFF REVIEW DUE: <br /> OT SCHEDULED: <br /> $ $ � OT COMPLETED: <br /> ACTION DATE ACTION DATE ACTION DATE <br /> ACKMIOYLG/COMMTMMT LTR REQSTD INCOMPLETE/ADDTHL INFO REQSTD SRP DUE <br /> ACKMOYLG/COMMTMMT LTR RECVD REVISION REQSTD PR DUE <br /> RWQC:B COMMENTS REPORT REVIEW COMPLETE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADOTNL INFO RECVD DENIED REVISION DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> L"E" <br /> REVIEW COMPLETE COMMENT LTR SENT PROJECT COMPLETE/FINAL BILL <br /> FOR AGENCY USE ONLY <br /> SITE MITIGATION PROGRAM FEE BASE MINIMUM HOURS MINIMUM AMOUNT RECEIVED DATE RECEIPT AMOUNT <br /> SCHEDULE FEE FOR SERVICE FEE RECEIVED BY # DUE <br /> UGT CORRECTIVE ACTION OVERSIGHT (CAP) 553.00/ <br /> HOUR 5 HOURS 5365.00 <br /> HAZARDOUS MATERIAL TRANSMISSION S53.00/ <br /> PIPELINE ASSESSMENT OVERSIGHT HOUR 5 HOURS S265.00 <br /> ENVIRONMENTAL ASSESSMENT WORKPLN/ $53.00/ <br /> REVIEW AND INSPECTIONS HOUR 3 HOURS $159.00 <br /> OTHER GOVERMENT AGENCY OVERSIGHT 553.00/ <br /> WORKPLAN/REVIEW AND INSPECTIONS HOUR 3 HOURS $159.00 <br /> BASE AMOUNT RECEIVED DATE PERMIT ISSUANCE { <br /> PERMIT ACTIVITY FEES FEE RECEIVED BY $ DATE <br /> WELL/BORING PERMIT APPLICATION .00 <br /> (monitorinp/extraction/vapor watts, EACH <br /> soit borirgs, vapor surveys, etc.) APPLC <br /> WELL DESTRUCTION PERMIT APPLICATION .00 <br /> EACH <br /> APPLC <br /> F.H 29 (BILFRM126 revised 5/91) <br />