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SAN JCIAQ1IW&WY • PUBLIC NEALTN SERVICES/ENVIRONMENA40kALTH DIVISI 1, <br /> NON-LOP SITE NITICIATION/ASSESSMENT SUBMITTAL LOG <br /> SITE ADDRESS LEAD AGENCY <br /> SITE CGDE # D PROGIELEMENT 2„ BILLING CODE ASSIGNED TO <br /> TITLE OF SUBMITTALS TYPE CODE <br /> DATE RECEIVED DATE ON SUBMITTAL Zj OT REQUEST OT REQUEST DATE <br /> PERMIT FEE PD CK #/ SH DATE REVIE FEE PD CK #/CASH DATE STAFF REVIEW DUE: <br /> OT SCHEDULED: <br /> � Z 3 = OT COMPLETED: <br /> FACKNWW <br /> ACTION DATE ACTION DATE ACTION DATE <br /> LG/COMMTNNT LTR REGSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE <br /> RWQCB COMMENTS REPORT REVIEW COMPLETE PAR DUE ++ <br /> i <br /> OTHER AGENCY APPROVAL IFILEA0 ACTION FRP DUE <br /> ADDENDUM/ADOTNL INFO RECVD DENIED REVISION DUE <br /> PERMIT ISSUED Y / B. SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN REVIEW COMPLETECOMMENT LTR SENT PROJECT COMPLETE/FINAL BILL <br /> FOR AGENCY USE ONLY <br /> SITE MITIGATION PROGRAM FEE BASE MINIMUM HOURS MINIMUM AMOUNT RECEIVED DATE RECEIPT AMOUNT <br /> SCHEDULE FEE FOR SERVICE FEE RECEIVED BY # DUE <br /> UGT CORRECTIVE ACTION OVERSIGHT (CAP) $S3.00/ <br /> HOUR 5 HOURS $265.00 <br /> HAZARDOUS MATERIAL TRANSMISSION $53.00/ <br /> PIPELINE ASSESSMENT OVERSIGHT HOUR 5 HOURS $265.00 <br /> ENVIRONMENTAL ASSESSMENT WORKPLN/ 553.00/ <br /> REVIEW AND INSPECTIONS HOUR 3 HOURS $159.00 <br /> OTHER OOVERNMENT AGENCY OVERSIGHT $53.00/ <br /> WORKPLAN/REVIEW AND INSPECTIONS HOUR 3 HOURS 5159.00 <br /> REVIEW <br /> AMOUNT RECEIVED DATE PERMIT ISSUANCE <br /> PERMIT ACTIVITY FEES FEE RECEIVED BY # DATE <br /> WELL/BORING PERMIT APPLICATION $89.00 <br /> (Monttorfrg/extraction/vepor welts, EACH <br /> soft borfngs, vapor surveys, etc.) APPLC <br /> WELL DESTRUCTION PERMIT APPLICATION $60.00 <br /> EACH <br /> APPLC <br /> EH 29 06 (SILFRMI2 revised 5/91) <br />