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..,„,,,c ,tic�rtY�❑ VG/F:.b/`jam -i <br />'Site Code: 1765 �� s <br />Site Name: BEACON CARDLOC$4TATION #27 Lead Agency: <br />iE <br />Address: r <br />.3300 WATERLOO RD Contact: 4 <br />City: STOCKTON Zip: 95205Ph�one: <br />Billing/responsible Party Information �y <br />Pilling Name: Name: li Bill Info OK? <br />Address: <br />City: estate: Zip: <br />Contact: Phone <br />Property Owner/Operator ig <br />Name: Phone: <br />Address: <br />City: State: `Zip: <br />Client Information (if different from Owner/Operator) <br />!Name: Phone: <br />Address: is <br />City: State: Zip: <br />Applicant's name, date sinned, title <br />Name., bate: <br />Title: f <br />s <br />f <br />Consultant Company: SSB ENVIRONMENTAL j <br />Contact Name: Phone: <br />Other Contact name or Info: Phone: <br />:o <br />Program Element: 3526 Billing Code: Assigned To: MM .f <br />ss G <br />Title of Submittal: WORKPLAN FOR ADDN ASST <br />Date of Submittal: 02/23/93 OT Reques=NOT <br />Request' Date: <br />Action Date <br />;R <br />Type of Submittal: if Work Plan for Permit Activity i <br />i� <br />Permit Fee Plaid <br />89.00 <br />Revision Regsted <br />PRjDue <br />RWDCB Comments <br />Check No. /Cash <br />4608 <br />Otter Agency Apr <br />File/No Action <br />FRS' Due,i <br />Date Paid <br />0e/26/93 <br />Re�yision Due <br />I <br />Special Permit Issued: <br />Permit Fee paid <br />0.00 <br />Comment Ltr Sent <br />; <br />Check No./Cash <br />' Date Paid <br />{ <br />?� I <br />Staff Review Due: OT Scheduled: OT Completed: <br />a <br />Action Date <br />Action Date <br />Action Date <br />Ack/Cam Ltr Req <br />lAck/Com <br />Add. Info Regstd <br />Srp Due' <br />Ltr Recd <br />Revision Regsted <br />PRjDue <br />RWDCB Comments <br />Report Revw Camp <br />Par Due' <br />Otter Agency Apr <br />File/No Action <br />FRS' Due,i <br />Add. Ire j <br />Denied <br />Re�yision Due <br />iWr <br />Special Permit Issued: <br />Oth Agency Due <br />Wr mS^' <br />Comment Ltr Sent <br />Project!! Complt <br />