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SAN JOAQUIN LZ;odTY - PUBLIC HEALTH SERVICES/ENVIRMOR HLl.—efH DIVISION <br /> SITE MITIGATION SUBMITI`AL� <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY �/ J SUBMITTAL LOG NUMBER <br /> GT SITE 23. SSESS- DHS / RWQCB 22. NVIRON ASSES 22.48 THER (PROD/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # / COMPUTER #IJOF SERVICE FROM _/_/ TO <br /> LOC CODE DISTRICT / SSIGNED TO <br /> YPE OF SUBMITTAL or /0 <br /> // FOD <br /> rESCRIPTION OF SERVICE �//`1 4�x CV/� <br /> DATE RECEIVED r// / l� DATE OF SUBMITTAL —/ T REQUESTED ATE OT REQUESTED / I <br /> IERMIT FEE PD (�� K#/CASH / C/ ATE 9 EVIEW FEE PD /S cj K#/CASH Z/& ATE fs/ Q <br /> STAFF REVIEW DUE ( / / OT SCHEDULED /_/_ /OT COMPLETED_/_/_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE <br /> WQCS COMMENTS REVIEW COMPLETE PAR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED 3THER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT 3ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> Fee is Due: Per Unit Per Site _Each <br /> illing emittance Amount emit Checked <br /> Program Element ase Exptanation Date Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight <br /> State/Federal Authorized) 53.00/hr 5 hour minimum <br /> Hazardous Material Transmission <br /> ipeline Assessment Oversight 53.00/hr 5 hour minimum <br /> nvirormental 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. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM12B <br />