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r�aa nu■urr 7J-rl3! uatie rceceivea 104/14/73 <br /> Site Code: 1400123 <br /> Site Nate: BILL'S BAIT & BEACON GAS Lead Agency: <br /> Address: 515 W ELEVENTH ST Contact: <br /> City: TRACY Zip: 95376 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 of 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: GAS <br /> Contact Name: Phone: <br /> Other Contact name or Info: Phone: <br /> Program Element: 3526 Billing Code: Assigned To: ML <br /> Title of Submittal: QM REPORT <br /> Date of Submittal: 04/01/93 OT 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 <br /> Date Paid 1 11 <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> Ack/Com Ltr Req ;Deni <br /> . In o Re Srp Due <br /> Ack/Co■ Ltr Recd i egsted R Due <br /> RWQCB Comments Comp LII3d �3 Due <br /> Othr Agency Appr e 111 :: Due <br /> Add. Info Recvd Revision Due <br /> Permit Type: Speci Permit Issued: 0th Agency Due <br /> Wrkpin Revw Comp Comment Ltr Sent Project Complt <br /> r <br />