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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ NVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION SUBMITTAL / <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY �/ ! SUBMITTAL LOG NUMBER <br /> GT SITE 23. �SSESS- DHS / RWQCB 22. NVIRON ASSESS 22.48 THER (PROD/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # COMPUTER # DATES OF SERVICE FROM /_/_ TO _/_/_ <br /> Y LOC CODE DISTRICT hIGNED TO <br /> YPE OF SUBMITTAL or ` YPE <br /> ESCRIPTION OF SERVICE ODE �. <br /> DATE RECEIVED fJ ' 1 DATE OF SUBMITTAL ( T REQUESTED ATE OT REQUESTED / / <br /> ERMIT FEE PD K#/CASH ATE EVIEW FEE PD ` K#/CASH `c� S!_ ATE <br /> STAFF REVIEW DUE _/�/_ OT SCHEDULED _/_/_ ,OT COMPLETED_/_/_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD R DUE <br /> WQCS COMMENTS REVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> DENDUM/ADDTNL INFO RECVD DENIED EVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED DTHER AGENCY DUE DATE <br /> RKPLAN APPROVED ICOMMENT LTR SENT 3ILLING FORM SUBMITTED <br /> FOR AGENCY USE ON Y <br /> Fee is Due: _Per Unit _Per Site _Each <br /> ill ng emittance Amount emit Checked <br /> Program ElementaseExplanation Dat Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight <br /> State/Federal Authorized) 53.00/hr 5 hour minimum <br /> azardous Material Transmission <br /> ipeline Assessment Oversight 53.00/hr 5 hour minimum <br /> nvironmental Assessment Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By late F <br /> pt No. ssuance Date ailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 8ILFRM128 <br />