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Submttal Dumber 93-080 Date Received 01/25/93 y <br /> Site Cade: 1299 t <br /> Site !Name: THRIFTY OIL STA #171 Leadlpgenc,y: <br /> Address: 1250 N WILSON WY Contact: LARRY HAWKS l <br /> City: STOCKTON Zip: 95205iPhone:209 463•-6793 <br /> II <br /> Billing/responsible Party Information <br /> 1 <br /> I! . <br /> Billing Name: { Bill Info OK? <br /> Address: j <br /> City: State: Zip: <br /> Contact: phone <br /> Property Owner/Operator <br /> Name: Phone: <br /> Address: i� <br /> City: State: I. Zip: <br /> r Client Information (if different from Owner/Operator' ) <br /> ij <br /> Name: Phone: i <br />+ Address: <br /> City: State: Zip: <br /> Applicant' s name, date signed, title <br /> i, <br /> Name: Date: <br /> Title: <br /> .p <br /> Consultant Company: <br /> Contact Name: PETER D'AMICO Phone: <br />€ Other Contact name or Info: Phone: <br /> r <br /> Program Element: 3526 Palling Code: Assigned To:. MC <br /> Title of Submittal: SITE ASST REPORT <br /> 16 Date of Submittal: 01/20/93OT Request: N OT Request Date: <br /> i� I <br /> i Type of Submittal: 3 Assessment Report <br /> Permit Fee Paid 0.00 <br /> Check No. /Cash <br /> Date Paid <br /> I4 <br /> Permit Fee Paid 0.00 <br /> J Check No. /Cash <br /> tf Date Paid <br /> IL <br /> Staff Review Dire: OT Scheduled: �� OTCompleted: <br /> �. <br /> Action Date Action Date Action Date E <br /> AckfCom Ltr Req Add. Info 51_d�-�� Srp Due <br /> IlAck/Com Ltr Recd iRevi ted �Que <br /> RWQCB Comments Rep l q3 Par uue <br /> Othr Agency Appr File/ —F� Due <br /> Add. Info Recvd Denied Revision Due <br /> II <br /> - it <br /> Permit Type: pe ted: th Agency Due Ii <br /> I �IWrkpin Revw Comp 14 Pro:'ect Comolt kl <br />