Laserfiche WebLink
SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY ! / 7/SUBMITTAL LOG NUMBER <br /> GT SITE 23. SSESS- DHS / RWQCB 22. NVIRON ASSES 2.4 THER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # /„ COMPUTER #15C <br /> DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT SSIGNED TO ifh I Z zz <br /> YPE OF SUBMITTAL or <br /> ESCRIPTION OF SERVICE ZAr C ODE <br /> DATE RECEIVED 3 / / l / DATE OF SUBMITTAL T REQUESTED ATE OT REQUESTED <br /> J / <br /> ERMIT FEE PD D-e [K#/CASH �:EATE ? g EVIEW FEE PD 7 —c� k#/CASH �� ATE 3 1 3 <br /> STAFF REVIEW DUE _/_/_ OT SCHEDULED _/ /_/_ / /OT COMPLETED_/_/_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> %CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD RR DUE <br /> WQCB COMMENTS REVIEW COMPLETE DAR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> DENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site _Each <br /> illing emittance Amount emit Checked <br /> Program Element ase xplanation Date Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight <br /> State/Federal Authorized) 53.00/hr 5 hour minimum <br /> azardous Material Transmission <br /> ipeline Assessment Oversight 53.00/hr 5 hour minimum <br /> nvironmental Assessment Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimus <br /> eceived By ate IR <br /> eceipt No. 1 11 <br /> ssuance Date 14 <br /> ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM12B <br />