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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISI <br /> SITE MITIGATION/ASSESSMENT SUBMITTAL LOG 4i2.IIZ <br /> SITE ADDRESS I — LEAD AGENCY <br /> AGENCY CONTACT <br /> CONSULTANT CO <br /> PHONE W/AREA CD <br /> CONTACT NAME PHONE <br /> OTHER CONTACT NAME or INFO PHONE <br /> SITE CODE # D 3 PROG/ELEMENT 2_2. BILLING CODE S ASSIGNED TO <br /> TITLE OF SUBMITTAL: l N l <br /> DATE RECEIVED C�Z DATE ON SUBMITTAL L(f OT REQUEST OT REQUEST DATE <br /> TYPE OF 5 BMITTAL CODE TYPE OF SUBMITTAL CODE <br /> RE-EXCAVATION WKPLN 1 PERMIT APPLICATION W/o WRKPLN 10 PERMIT FEE PD CK #/CASH DATE <br /> SITE ASSESS WKPLN 2 WORKPLAN for PERMIT ACTIVITY 11 $ <br /> ASSESSMENT REPORT 3 OTHER WRKPLN W/o PERMIT ACTIVITY 16 S <br /> ASSESS RPT W/WKPLN 4 OTHER AGENCY REPORT 17 s <br /> REMED ACTION PLN (RAP) 5 LETTER 18 s <br /> ASSESS RPT W/RAP 6 PUBLIC PART INFO 19 REVIEW FEE PO CK #/CASH DATE <br /> FINAL REMED PLN (FRP) 8 S <br /> QRTLY RPT/POST REMED MONITORING 9S <br /> STAFF REVIEW DUE: _/_/_ OT SCHEDULED: _/_/_ OT COMPLETED: <br /> ACTION DATE ACTION DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCCMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REOSTO PR DUE <br /> RWOCB COMMENTS REPORT REVIEW COMPLETE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADDTNL INFO RECVO DENIED REVISION DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN REVIEW COMPLETE COMMENT LTR SENT PROJECT COMPLETE/FINAL BILL <br /> EH 29 03 (PLNLOG revised 5/91) <br /> I <br />