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SAN JOAOUIR OTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL H*H DIVISION <br /> SITE MITIGATION SUBMITTAL <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY SUBMITTA 'LOG NUMBER <br /> GT SITE 23. SSESS- DHS / RWQCS 22._ NVIRON ASSE 22.48 THER (PROG/ELEMENT _ _ PILOT PROGRAM <br /> WEEPS #/SITE CODE # �i1 � COMPUTER # DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE I DISTRICT SSIGNED TO I FT <br /> TYPE OF SUBMITTAL or � YPE <br /> E[ E ' <br /> I PTION ODEDRECEIVED / /Cn/ DATE OF SUBMITTAL 2 /��/ T REQUESTED ATE OT REQUESTED / / <br /> ERMIT FEE PD �' I�L/7) K#/CA/SH A) ATE � I /c� EVIEW FEE PD � � K#/CASH 6 5, ATE S/ <br /> STAFF REVIEW DUE _/_/_ OT SCHEDULED _/_/_ OT COMPLETED_/_/_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> CKNOWLG/CGMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> %CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD DR DUE <br /> WQCB COMMENTS REVIEW COMPLETE DAR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> DENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED )THER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT 31LLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: _Per Unit _Per Site Each <br /> iLling emittance Amountemit Checked <br /> Program Element ase xplanation Date 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 mini mum <br /> nvironmentaL Assessment Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> 7/y,� <br /> ther Government Oversight Work Plan/ pF'�b, �Y9� <br /> Report Review and Inspections 53.00/hr 3 hour mini mum T� <br /> eceived By ate eceipt No. ssuance Date /CFS+ filed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />