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SAN JOAQUIN CRAY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE TH DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> FF RE'• <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY /� Q 1991 <br /> L L SUBMITTAL LOG NUMBER <br /> GT SITE 23._ SSESS- DHS / RWQCB 22. NVIRON ASSESS 22.48 THER (PROD/ELEMENT <br /> PILOT PROGRAM <br /> WEEPS #/SITE CODE # p16) <br /> Fly COMPUTER # =OFE FROM _/_/_ TO <br /> LOC CODE DISTRICT SSIGNED TO <br /> YPE OF SUBMITTAL or � TYPE <br /> ESCRIPTION OF SERVICE j CODE <br /> DATE RECEIVED 7/ 5—/�/ DATE SUBMITTAL �j/ T REQUESTED ]DATE OT REQUESTED <br /> ERMIT FEE PD K#/CASH GATE - /5 EVIEW FEE PD K#/CASH 5— ATE <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 R DUE <br /> WQCB COMMENTS REVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION IRP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED 3THER AGENCY DUE DATE <br /> RKPLAN APPROVED 1COMMENT LTR SENT ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site _Each <br /> Ming 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 /> nvirormental Assessment Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By ate eceipt No. ssuance Date IMaRed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />