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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION/ASSESSMENT SUBMITTAL LOG #�- z <br /> Y <br /> SITE ADDRESS Ah S LEAD AGENCY <br /> AGENCY CONTACT <br /> CONSULTANT CO <br /> PHONE W/AREA CD <br /> CONTACT NAME % ONE Sz <br /> �Q <br /> OTHER CONTACT NAME or INFO PHONE <br /> SITE CODE # PROG/ELEMENT 12:2. 1 <br /> BILLING CODE / 1 ASSIGNED TO <br /> /J <br /> TITLE OF SUBMITTAL: / I <br /> DATE RECEIVED % DATE ON SUBMITTAL // OT REQUEST OT REQUEST DATE <br /> TYPE OF EMIT AL CODE TYPE 0 SU ITTAL CODE <br /> RE-EXCAVATION WKPLN 1 PERMIT APPLICATION W/o WRKPLN 10 PERMIT FEE PD CK #/CASH DATE <br /> SITE ASSESS WKPLN 2 WORKPLAN for PERMIT ACTIVITY 11 $ <br /> ASSESSMENT REPORT 3 OTHER WRKPLN w/o PERMIT ACTIVITY 16 $ <br /> ASSESS RPT w/WKPLN 4 OTHER AGENCY REPORT 17 S <br /> REMED ACTION PLN (RAP) 5 LETTER 18 $ <br /> ASSESS RPT w/RAP 6 PUBLIC PART INFO 19 REVIEW FEE PD CK #/CASH DATE <br /> FINAL REMED PLN (FRP) 8 S <br /> ORTLY RPT/POST REMED MONITORING 9 S <br /> STAFF REVIEW DUE: _/_/_ OT SCHEDULED: _/_/_ OT COMPLETED: <br /> ACTION DATE ACTION GATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REOSTO INCCMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> ACKNCWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE <br /> RWOCS COMMENTS REPORT REVIEW C ETE '{ PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO AC ✓ FRP DUE <br /> ADDENDUM/ADDTNL INFO REM DENIED REVISION DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN REVIEW COMPLETE COMMENT LTR SENT PROJECT CCMPLETE/FINAL BILL <br /> EH 29 03 (PLNLOG revised 5/91) <br />