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Submttal mumoer lie L, ^=�=^, <br /> !Site Code: 2556 J <br /> ISite Name: REYNOSO CONCRETAG;eONSTRUCTION Lead Anency: <br /> Address: 729 S COMMERCE ST <br /> Billing/responsible Party Information � <br /> Billing Name: Bill Info OK? <br /> City- State- Zip: <br /> Contact : Phone <br /> Property Owner/Operator <br /> Name- Phone: <br /> City- State- Zip. <br /> Client Information (if different from Owner/Operator) <br /> Name: Phone: <br /> City: State- Zip: <br /> Applicant' s name, date signed, title <br /> Name: Date: <br /> Title- <br /> Consultant Company: GAS <br /> Contact Name: Phone- <br /> Other Contact name or Info: Phone: <br /> Program Element- 3527 Billing Code- Assigned To:--DP-%4., <br /> Title of Submittal: WORKPLAN FOR EXCAVATION <br /> 1: 02/17/9- OT Request T R6quest Date: <br /> Type of Submittal : 2 Site Assessment Work Plan <br /> Permit Fee Paid 0.00 <br /> Check No. /cash <br /> Date Paid <br /> Permit Fee Paid 0.011) <br /> Check No. /Cash <br /> Date Paid <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> 1RWDCB Comments [Repo t Due <br /> 1Add. Info Recvd I Deni9ee i Revision Due <br /> 11 Permit Type: I Special Permit Issued- Oth Agency Due <br /> IWrkpin Revw Comp Comment Ltr Sent Project Complt <br />