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Submttal Number 93-394*vftw Date Received 05/03/93 �,� <br /> Site Code : 1211 <br /> Site Name : REGAL SERVICE STATION Lead Agency : <br /> Address : 6425 PACIFIC AV Contact : <br /> City : STOCKTON Zip: 95207 Phone : <br /> Billing/responsible Party Information <br /> Billina 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 /> Consultant Company : WEGE <br /> Contact Name : Phone : <br /> Other Contact name or Info : Phone: <br /> -T Assigned To: MM <br /> am Element : 352� Billing Code: <br /> Title of Submittal : QMR <br /> Date—of- Submittal : 04/29/93 1 OT Request : N I 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 <br /> Staff Review Due : OT Scheduled : OT Completed: <br />