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• -„••��, +�+ ws LCl4r nccrivru VO/ 10/7.5 <br /> Site Code: 1841 %/ <br /> Site Name: BEACON STATION #695 Lead Agency: <br /> Address: 900 S CHEROKEE LN Contact: <br /> ! City: LODI Zip: 95840 Phone: <br /> Billing/responsible Party Information <br /> Billing Name: Bill Info OK? <br /> Address: <br /> City: State: Zip: <br /> Contact: 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 /> Name: Date: <br /> Title: , <br /> Consultant Company: AEGIS <br /> Contact Name: Phone: <br /> Other Contact name or Info: Phone: <br /> Program Element: 3526 Billing Code: Assigned To: LT <br /> Title of Submittal: QM REPORT <br /> Date of Submittal: 03/04/93OT Request: N OT Request Date: <br /> Type of Submittal: 9 Quarterly Report/Post-Remedial Monitoring <br /> Permit Fee Paid 0.00 <br /> Check No. /Cash <br /> Date Paid <br /> Permit Fee Paid 0.00 <br /> Check No. /Cash 41 <br /> Date Paid <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> Ack/Com Ltr Req Add. Info Srp Due <br /> Ack/Com Ltr Recd Re on eq R Due y, <br /> RWQCB Comments t v Par Due <br /> Othr Agency Appr Due <br /> Add. Info Reevd nie �� `�` �DP <br /> vision Due <br /> Permit Type: S ecial Per ue : Oth Agency Due <br /> Wrkpin Revw Comp Comment Ltr Sent Project Complt �� <br />