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k Site Cade: 112E { <br /> Site !Name; PP OIL #1119 Lead Agency.- <br /> Address: <br /> gency:Address: 1469 E HAMMER LN Contact: LOU PARISI <br /> ` City: STOCKTON Zip: Phone: 209 478-152 � <br /> ; Billing/responsible Party Information <br /> I <br /> Billing Name: Bill Info OSS? <br /> Address: <br /> City: State: Zip: <br /> Contact: Rhone <br /> Property Owner/Operator <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> Client Information 4if different from Owner/Operator) <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> Applicant' s name, date signed, title <br /> !Name: Date: � <br /> Title: <br /> E Consultant Company: RESNA <br /> Contact Name; Phone: <br /> Other Contact name or Info: Phone: <br /> Program Element: 2950 Pilling Code: Assigned To: MC ` <br /> k' 1 <br /> ::Title of Submittal : WELL LOGS <br /> t. <br /> Date of Submittal: 01/19/93 OT Request: N OT Request Date: L <br /> F' 1 <br /> Type of Submittal : 18 Letter <br /> Permit Fee Paid 0.00 <br /> kII Check No. /Cash <br /> IE <br /> Date Paid <br /> x E <br /> t Permit Fee Paid 11.00 <br /> i <br /> Check No. /Cash <br /> Date 'Paid <br /> r - <br /> Staff Review Due: OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> � Ack/Com Ltr Rea Add. Info Regst _ Srp Due <br /> AcklCom Ltr Recd Revifd <br /> a sted ,[� PR Due <br /> iRWGfC$ Comments Re �� F�ai^ Due <br /> POthr Agency Appr Fi aion F pue <br /> Add. Info Recvd De iRevision Due <br /> Permit Type: Spec sued: Oth Agency Due <br /> ! Wrkpin Revw Comp +Comment Ltr Sent 1 Project Complt it <br /> i <br /> it <br />