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Permit Type:�Yl _ Special Permit Issued: Oth Agency Due <br /> Wrkpin -Revw Comp 16 Com- t Ltr ,Sent project C^--.lt <br /> Submttal Number 93-378 Date Received 04/22/93 <br /> Site Code: 1786123 <br /> Site Name: CHEVRON STATION #96465 Lead Agency: <br /> Address: 5608 N PERSHING AV Contact : <br /> City: STOCKTON Zip: 95207 phone: <br /> Billing/responsible party Information <br /> Billing Name: Bill Info OK? <br /> Address: <br /> City: State: Zip: <br /> Contact: Phone <br /> Property Owner/Operator <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> Client Information of different from Owner/Operator) i <br /> 1 <br /> Name: Phone: <br /> Address: <br /> City: State: Zip: <br /> I <br /> Applicant' s name, date signed, title <br /> i <br /> Name: Date: <br /> Title: <br /> Consultant Company: ALTON <br /> Contact Name: Phone: <br /> Other Contact name or Info: phone: <br /> tf <br /> program Element: 3526 Billing Code: Assigned To: LT <br /> -- <br /> Title of Submittal: QM REPORT <br /> Date of Submittal : 01/29/93 OT Request: N OT Request Date: <br /> Type of Submittal : 9 Quarterly Report/Past-Remedial Monitoring <br /> Permit Fee Paid 0.00 <br /> Check No. /Cash <br /> Date Paid <br /> permit Fee Paid 0.00 <br /> Check No. /Cash <br /> Date Paid <br /> Staff Review Due: OT Scheduled: CIT Completed: <br /> Action Date Action Date Action Date <br /> Ack/Com Ltr Req Add. Info Re Srp Due <br /> Ack/Com Ltr Recd Revision `� 12 ,, Due <br /> RWQCB Comments •Report m L�'Z r Due <br /> Othr Agency Appr File/Na A FRP Due <br /> ,n.,., r. r., o..—A n---A <br />