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u .+el �.n' vea ydbe fSrCB1VeU V1/C1!'yJ . <br /> Site Code: 1102 <br /> Site Name: COS/SMITH CANAL PUMP STA FadCAgency: LOP <br /> Address: FONTANA DR/SMITH CRNact: DON KING;City: STOCKTON Zip: 95204one: 209 944-8715 <br /> f <br /> Billing/responsible Party Information <br /> Billing Name'. Bill Info OR? <br /> Address: <br /> City: State: Zip: <br /> Contact: Phone 1 <br /> t <br /> Property Owner/Operator <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: ' <br /> iI <br /> Client Information (if different from Owner/Operator) <br /> r ' <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: , <br /> Applicant' s name, date signed, title <br /> Name: Date: j <br /> Title: I <br /> i <br /> Consultant Company: RESNA <br /> Contact Name: Phone: <br /> Other Contact name or Info: Phone: <br /> j <br /> +, Program Element: 3526 Billing Code: Assigned To: LT ly <br /> i <br /> Title of Submittal: QM REPORT <br /> Date of Submittal: 01/21/93 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 <br /> Staff Review Due: OT Scheduled: OT Completed- ' <br /> is <br /> Action Date Action Date Action Date <br /> JAck/Com Ltr Req Add. Info Reqstd Srp Due k <br /> Ack/Com Ltr Recd Revision Reqsted PR Due <br /> RWQCB Comments Report Revw Comp Par Due <br /> Othr Agency Appr File/No Action FRP Due <br /> Add. Info Recvd Denied Revision Due <br /> `)Permit Type: Special Per —i i <br /> Wrkpin Revw Comp `omm'ent4 Pro 'ect Complt <br /> L <br />