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auomscai wumoer yo—iav vase neceiveo tcicciya <br /> Site Code: 2498V j <br /> Site Name: DEL MONTE/DIS0 Lead Agency: <br /> Address: 110 N FILBERT ST Contact: <br /> City: STOCKTON Zip: 95205 Phone: <br /> Billing/responsible Party Information <br /> i <br /> Billing Name: Bill Info OK? <br /> Address: <br /> City: State: Zip: 1 <br /> Contact. Phone <br /> 4 <br /> Property Owner/Operator <br /> 1 Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> Client Information (if different from Owner/Operator) <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> Applicant' s name, date signed, title <br /> i <br /> Name. Date: <br /> + Title: <br /> Consultant Company: CH2M HILL <br /> Contact Name: Phone: <br /> i Other Contact name or Info: Phone: j <br /> '� Program Element: 3526 Billing Code: Assigned To: MC <br /> i <br /> Title of Submittal: QM REPORT <br /> + Date of Submittal : 02/10/93 OT Request: N OT Request Date: 1 <br /> Type of Submittal : 9 Quarterly Report/Post—Remedial Monitoring <br /> Permit Fee Paid 0. 00 , <br /> Check No. /Gash <br /> +� Date Paid 4 <br /> Permit Fee Paid 0.00 `I7y <br /> �? Check No. /Cash 1 <br /> !+ Date Paid +t <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> +Ack/Com Ltr Req . Add. Infj Reqs t Srp Due SS <br /> Ack/Com Ltr Recd Revis' gsted R Due <br /> �RWQCB Comments w Comp Z/�S 3 r Due <br /> Othr Agency Appr le �' F ' Due <br /> j Add. Info Recvd Denied Revision Due <br /> I Permit Type: Special ermit Issued: 0th Agency Due <br /> itI Wrkpin Revw Comp Comment Ltr Sent Project Complt y� <br />