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SAN JOAQUIN t,_,,TY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL H),N DIVISION <br /> SITE MITIGATION SUBMITTAL M�� 1 6 1991 <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY a'_2.q 7 SUBMITTAL LOG NUMBER <br /> GT SITE 23. �SSESS- DHS / RWQCB 22. NVIRON ASSESS 22.48 ITHER (PROG/ELEMENT PILOT PROGRAM:E <br /> WEEPS #/SITE CODE # G'j 0 7/ COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTI(RICT SSIGNED TO <br /> YPE OF SUBMITTAL I-V / � YPE <br /> ESCRIPTION OF SERVICE /w// OpE <br /> DATE RECEIVED / / / DATE OF SUBMITTAL S/ /g 13T REQUESTED ATE OT REQUESTED �/ /? /g/ <br /> IERMIT FEE PD [K#/CASH Z�py�s <br /> AT /6 EVIEW FEE PD 1 S�j K#/CASH �� ATE s d <br /> STAFF REVIEW DUE _/_/_ OT SCHEDULED /_/_/_ 1 OT COMPLETED—/_/_ 7 <br /> ACTION DATE ACTION DATE ACTION DATE <br /> %CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD 7 RP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE <br /> WQCB COMMENTS REVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION / RP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED EVISION DUE <br /> L <br /> ISSUED PECIAL PERMIT ISSUED THER AGENCY DUE DATE <br /> N APPROVED ^OMMENT LTR SENT 31LLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: Per Unit Per Site Each <br /> filling 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 /> nvironmental Assessment Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By ate eceipt No. 11 <br /> ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM12B <br />