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SAN JOAQUIN "- PUBLIC HEALTH SERVICES/ENVIRONMENTAL k4 DIVISION.. <br /> 'P a <br /> DO NOT WRITE IN THIS AREA—AGENCY USE ONLY SUBMITTAL LOG NUMBER <br /> GT SITE 23.� SSESS- DHS / RWQC8 22. NVIRON ASSESS 22.48 IT- <br /> 3WEEPS <br /> HER (PROG/ELEMENT . PILOT PROGRAM <br /> b <br /> #/SITE CODE # �Q CCMPUTER # V�j :j DATES OF SERVICE FROM /�_ TO <br /> LOC CODE DISTRICT �? �SSIG9 ED TO �- <br /> PE OF SUBMITTAL or YPE <br /> ESCRIPTION OF SERVICE ODE / <br /> DATE RECEIVED / �j�/�J/ DATE OF, BMITTAL /�rf/ / T REQUESTED ATE OT REQUESTED <br /> FOR AGENCY USE ONLY <br /> Y <br /> ee is Due: Per Unit Per Site ^Each:' <br /> Ming emittance Amount emit Checked <br /> Program Element ase xplanation Date Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight 2 y} <br /> State/federal Authorized) 53.0,0/hr 5 hour minimus <br /> � 1 <br /> azardous Material Transmission t <br /> ipeline Assessment Oversight 53.00/hr 5 hour minimum <br /> nvirormental Assessment Work Plan/ 4 <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> Cher Government Oversight Work Plan/ H <br /> eport Review and Inspections 53.00/hr 3 hour minimus 3 <br /> eceived By ate eceipt No. ssuance Date ailed <br /> .... F <br /> . PAGE TWO OF TWO TTT <br /> res x. <br /> EH 23 074 (5/89) 89-006(IV)5/90 BILFRM" g+ <br />