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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONIMENTAL HEALTH DIVISION <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY TUBM1TTAL LOG NUMBER <br /> GT SITE 23. SSESS- DHS / RWQCB 22. NVIRON ASSESS 22.48 ITHER (PROG/ELEMENT PILOT PROGRAM <br /> EEPS #/SITE CODE # COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT SSIGNED TO <br /> YPE OF SUBMITTAL or TYPE <br /> ESCRIPTION OF SERVICE CODE <br /> DATE RECEIVED / / DATE OF SUBMITTAL / / T REQUESTED ATE OT REQUESTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site _Each <br /> filling emittance[Amountem <br /> it Checked <br /> Program Element ase xplanation Date Date emitted MOUNT DUE Amant <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 /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> Report 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 23 074 (5/89) 89-006(IV)5/90 BILFRM <br />