Laserfiche WebLink
SAN JOAQUIN'*,*","4 TY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL hTH DIVISION <br /> SITE MITIGATION SUBMITTAL M 113 j <br /> 1991 <br /> DO N07 WRITE IN THIS AREA USE ONLY _ �/—,Z Gf/f� <br /> SUBMITTAL LOG NUMBER <br /> GT SITE 23._ SSESS- DHS / RWQCB 22. NVIRON ASSES 22.48 THER (PROG/ELEMENT <br /> _, PIL07 PROGRAM <br /> WEEPS #/SITE CODE # COMPUTER # DATES OF SERVICE FROM <br /> TO <br /> LOC CODE DISTRICT SSIGNED TO J <br /> YPE OF SUBMITTAL or (lJ <br /> ESCRIPTION OF SERVICE i YPE <br /> CODE <br /> DATE RECEIVED �/ / DATE OF SUBMITTAL S%�Q / g/ T REQUESTED IDATE OT REQUESTED <br /> ERMI7 FEE PD K#/CASH ATE ::TEVIEW FEE PD K#/CASH ATE <br /> STAFF REVIEW DUE _/_/_ 07 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 R DUE <br /> WQCB COMMENTS EVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION IRP DUE <br /> DENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED )THER AGENCY DUE DATE <br /> LRKPLAN APPROVED [OMMENT LTR SENT ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> Fee is Due: Per Unit Per Site Each <br /> illi ng 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 J53-00/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 -TateF eceipt No. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />