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SAN JOAQUIN C&r4TY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE. H DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY /l'�l�F� SUBMITTAL LOG NUMBER <br /> GT SITE 23. ISSESS- DHS / RWQCB 22. NVIRON ASSES 22.48 ITHER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # / �j COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT / SSIGNED TO vv � <br /> YPE OF SUBMITTAL or YPE <br /> ESCRIPTION OF SERVICE ODE <br /> JDATE RECEIVED /�S/ DATE OF SUBMITTAL / /9/ T REQUESTED L ATE OT REQUESTED <br /> IERMIT FEE PDfn/J K#/CASH 7 ATE EVIEW FEE PD �� K#/CASH STAFF REVIEW DUE / / / vOT SCHEDULED / / OT COMPLETED /[�Y/��ATE <br /> / <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 PIR DUE <br /> WQCB COMMENTS REVIEW COMPLETE DAR 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 ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site _Each <br /> illing 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. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM12B <br />