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y" SAN 10AWIN r ^`'TY — PUBLIC HEALTH SERVICES/ENVIRONMENT {' r i DIVISION. <br /> SITE MITIGATION/ASSESSMENT SUBMITTAL.�G <br /> SITE NAME ---� OhIR LEAD AGENC <br /> ADDRESS AGENCY CONTACT <br /> CITY ZIP PHONE w/AREA CD <br /> CONSULTANT COMPANY CONTACT p <br /> OTHER CONTACT NAME or ON! <br /> UGT SITE 23. ASSESS—DHS / RWOCB 22. ENVIRON ASSESEE 22.48 PILO 23.,12 FIND SDUR / F TASK t <br /> SWEEPS #/SITE CODE # � G/ DIST � LOC CD O ASSIGNED TO <br /> TITLE OF SUBMITTAL: <br /> R <br /> F <br /> E RECEIVED I 1 DATE OF SUBMITT 2Z/-2--7/A BILLING FORM INITIATED _1_I OT REGST <br /> TYPE OF SUBMITTAL (PILOT) COD TYPE OF SUBMITTAL (OTHER) COD FEE PD CK #/C951 DATE <br /> RE—EXCAV/SOIL CONTAMINATION WORKPLAN (SCWP) 1 PERl41T APPLICATION 10 <br /> SOIL CONTAMINATION REPORT/REMEDIATION PLAN (SRP) 2 WORKPLAN for PERMIT ACTIVITY '11 <br /> PRELIMINARY REPORT (PR) 3 ASSESS REPORT 13 <br /> PR/with ADDTL ASSESS PROPOSAL 4 ASSESS REPORT/with WORKPLAN 14 <br /> PROBLEM ASSESSMENT REPORT (PAR) 5 ORTLY/MONITORING REPORT 15 <br /> PAR/with REMEDIAL ACTION PROPOSAL 6 OTHER WRKPL.AN w/o PERMIT ACTIVITY 16 <br /> ADDITIONAL ASSESSMENT PROPOSAL 7 <br /> FINAL REMEDIATION PLAN (FRP) 1��V <br /> ORTLY REPORT/POST REMED MONITOR <br /> STAFF REVIEW DUE _/ l� O /SCHEDULED —1�I,., OT COMPLETED I I <br /> ACTION DATE ACTION. DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REDSTD INCONPLETEIADDtIL INFO REOST %;7/1 Q SR' DUE <br /> ACKNOWLG/CDMMTMNT LTR RECVD REVISION REUSTD PR DUE <br /> RWDCB COMMENTS REVIEW COMPLETE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUX/ADDTNL INFO RECVD DENIED �r, REVISION DUE <br /> PERMIT ISSUED ISPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN APPROVED COMMENT LTR SENT BILLING FORM SUBMITTED <br /> EH 23-117 89-57(IV)12/89 PLNLOG <br /> ti <br />