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f ++ Su6etta1 Nusber 93-224 Date Received 03/44/93 J� L Site Code: 2436 : ISite Name: C M WEBER Lead Agency: Address: 141 N EL DORADO Cont . act: City: STOCKTON Zip: 95201 Phone- Billing/responsible Party Information Pilling Name: Bill Info OK? Address: City: Stater Zip: Contact: Phone Property Owner/Operator Name: Phone: ; Address: City: Stater Zip: i a Client Information (if different from Owner/Operator) Name: Phone: Address: I City: State: Zip: Applicant' s name, date signed, title Name: Date: Title: Consultant Company: RESNA Contact Name: Phone: Other Contact name or Info: Phone: i ILP rogram Element: 3526 Pilling Cade: Assigned To:. MM Title of Submittal: QM REPORT i { q Date of Submittal: 0.'/03!93 OT Re nest•. OT Request Date: Type of Submittal: 9 Quarterly Report/Post—Remedial Monitoring { � - Permit Fee Paid 0.00 Check Na. /Cash i Date Paid a Permit Fee Paid 0.00 Check No. /Cash Date Paid Staff Review Due: OT Scheduled: OT Completed: Action Date Action Date Action Date i Ack/Com Ltr Req Add. I Reqstdeql�- ' Due Ack/Com Ltr Recd Rev- i eq PR D e RWQCP Comments RePar ue Othr Agency Appr Fi tion P Due Add. Info Recvd De iie Revision Due Permit Type: Special Perma 'sued: Oth Agency Due Wrkpin Revw_Comp Comment Ltr Sent 'Project Complt }