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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DTVI <br /> SITE MITIGATION/ASSESSMENT SUBMITTAL LOG # <br /> [SITE ADDRESS r 0 !j (lap LEAD AGENCY <br /> AGENCY CONTACT <br /> CONSULTANT CO <br /> PHONE w/AREA CD <br /> CONTACT NAME PHONE C?�/) Q 67 <br /> OTHER CONTACT NAME or INFO PHONE J <br /> SITE CODE tt `(j j ` PROD/ELEMENT BtLIlHG^C00 ASSIGNED TO «l�� <br /> TITLE OF SUBMITTAL: /, f ��� � �����, <br /> DATE RECEIVED DATE ON SUBMITTAL 1 /e OT REQUEST OT REQUEST DATE <br /> TYPE OF SUBMITTAL CODE TYPE OF SUBMITTAL CODE <br /> RE-EXCAVATION WKPLN 1 PERMIT APPLICATION w/o WRKPLII 10 PERMIT FEE PD CK #/CASH DATE <br /> SITE ASSESS WKPLN 2 WORKPLAN for PERMIT ACTIVITY 11 $ <br /> ASSESSMENT REPORT 3 OTHER WRKPLH w/o PERMIT ACTIVITY 16 S <br /> ASSESS RPT w/WKPLN G OTHER AGENCY REPORT 17 f <br /> REMED ACTION PLN (RAP) 5 LETTER 18 $ <br /> ASSESS RPT w/RAP 6 PUBLIC PART mro 19 REVIEW FEE PD CK #/CASII DATE <br /> FINAL REMED PLN (FRP) 8 $ <br /> QRTLY RPT/POST REMED MONITORING 9 x <br /> STAFF REVIEW DUE: / /_ OT SCHEDULED: / /_ OT COMPLETED: _/_/__ <br /> ACTION DATE ACTION I DI:TP ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCCMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE <br /> RWQCB COMMENTS REPORT REVIEW COMPLEIE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADDTNL INFO RECVD DENIED REVISICN DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN REVIEW COMPLETE COMMENT LTR SENT PROJECT CC14PLETE/FINAL DILL <br /> EH 29 03 (PLNLOG revised 5/91) <br />