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SAN JOAQUIN Cu,,.(Y - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE„_iH DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY <br /> \ i —��74-- SUBMITTAL LOG NUMBER <br /> GT SITE 23._ SSESS- DHS / RWQCB 22._ NVIRON ASSES 22.48 THER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # <�`Y. OMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRICT SSIGNED TO <br /> PE <br /> FYPE <br /> ESCROIPTIONMOFT <br /> SERVICE <br /> ODE i% <br /> DATE RECEIVED �/� TZ/ �� DATE (§F SUBMITTAL > / /L�,j ttt777�TT REQUESTED ATE OT REQUESTED <br /> i <br /> ERMIT FEE PD K#/CASH ATE EVIEW FEE PD �'.�C� r K#/CASHATE <br /> �� � <br /> r <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 DR DUE <br /> WQCB COMMENTS REVIEW COMPLETE AR 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 BILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: Per Unit Per Site Ea <br /> ch <br /> ilting emittance Amount emit Checked <br /> Program Element 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 /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By ate Feceipt No. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />