Laserfiche WebLink
SAN JOAQUIN CU*URTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE".,�)iH DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY `( / 7 ;� SUBMITTAL LOG NUMBER <br /> GT SITE 23. SSESS- DHS / RWQCB 22. NVIRON ASSESS (22.48 HER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # j 7 COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT ISSIGNED TO <br /> 7 <br /> YPE OF SUBMITTAL or TYPE <br /> ESCRIPTION OF SERVICE /r// rJ��C��Jt-Y �� ODE <br /> DATE RECEIVED {f/ / C JDATE Of SUBMITTAL cl / �� / �� T REQUESTED I OATE OT REQUESTED <br /> ERMIT FEE PD K#/CASH I ID <br /> ATE EVIEW FEE PD >5 ; k#/CASH �ATE <br /> STAFF REVIEW DUE _/_/_ OT SCHEDULED _/_/_ / OT COMPLETED-/-/_ f� <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 /> WQCB 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 DTHER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT 31LLING 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 F7 Explanation 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 /> nvirormentaL Assessment Work Plan/ <br /> eport 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. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />