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SAN JOAQUIN COUNTY . PUBLIC HEALTH SERVICES/ENVIRONMENTAL 01'.0 IVIS(.Oy <br /> NON-LOP SITE MI TICATION/ASS'c SSME NT SUBMITTAL LOG `•y \� # <br /> SITE ADDRESS Ii 3 S LEAD AGENCY <br /> SITE CODE # 9a/ PROG/ELEMENT 22. BILLING CODE s ASSIGNED TO <br /> TITLE OF SUBMITTAL: <br /> N� TYPE CODE / <br /> DATE RECEIVED q' / DATE ON SU ITTAL / OT REQUEST OT REQUEST DATE / <br /> � u <br /> PERMIT FEE PD tK #/CASH DATE REVIEW FEE PD'/ CK #/CASH DATE STAFF REVIEW DUE: <br /> 8 OT SCHEDULED: <br /> $ OT COMPLETED: <br /> ACTION DATE ACTION <br /> DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCCMPLETE/ADDTNL INFO REQSTO SRP DUE <br /> ACKNCWLG/CCMMTMNT LTR RECVD REVISION REOSTD PR DUE <br /> RWOCB COMMENTS REPORT REVIEW COMPLETE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> PERMIT ISSUED W / a SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> ORKPLAH REVIEW COMPLETE CCMMENT LTR SEAT PROJECT CCMPLETE/FINAL BILL <br /> FOR AGENCY USE ONLY <br /> SITE MITIGATION PROGRAM FEE BASE MINIMUM HOURS MINIMUM AMOUNT RECEIVED DATE RECEIPT AMOUNT <br /> SCHEDULE FEE FOR SERVICE FEE RECEIVED BY <br /> # DUE <br /> UGT CORRECTIVE ACTION OVERSIGHT (CAP) 1853.00/ <br /> HOUR 5 HOURS $265.00 <br /> HAZARDOUS MATERIAL TRANSMISSION $53.00/ <br /> PIPELINE ASSESSMENT OVERSIGHT HOUR 5 HOURS 8265.00 <br /> ENVIRONMENTAL ASSESSMENT WORKPLN/ 853.00/ I <br /> REVIEW AND INSPECTIONS HOUR 3 HOURS <br /> q 8159.00 <br /> OTHER GOVERNMENT AGENCY OVERSIGHT <br /> WORKPLAN/REVIEW AND INSPECTIONS <br /> BASE AMOUNT RECEIVED DATE PERMIT ISSUANCE <br /> PERMIT ACTIVITY FEES FEE <br /> RECEIVED BY # DATE <br /> WELL/BORING PERMIT APPLICATION $x9.00 <br /> (monitoring/extraction/vapor wells, EACH <br /> At borings, vapor surveys, etc.) APPLC <br /> WELL DESTRUCTION PERMIT APPLICATION $60.00 <br /> EACH <br /> APPLC <br /> EH 29 06 (BILFRMI2 revised 5/91) <br />