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OAOUIN TY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALIE DTVI <br /> SAN J / <br /> SITE MITIGATION/ASSESSMENT SUBMITTAL LOG # -,►� <br /> LEAD AGENCY <br /> SITE ADDRESS <br /> r <br /> AGENCY CONTACT III <br /> CONSULTANT CO PIIONE w/AREA CD 1 <br /> i <br /> CONTACT NAME ` PHONE <br /> PHONE <br /> T_ <br /> OTHER CONTACT HAM or INFO <br /> SITE CCUE # 3 PRO./ELEMENT V2�,�-_ UILLON3 COBE --ASSIGNED TO �S <br /> TITLE OF SUBMITTAL: to <br /> ii <br /> DATE RECEIVED DATE ON SUBMITTAL / OT REQUEST OT REQUEST DATE <br /> TYPE OF SUBMITTAL CODE .__ TYPE OF SUBMITTAL CODE <br /> RE-EXCAVATION WKPLN 1 PERMIT APPLICJITtON ►+/o WRKPLII 1I3 PERMIT FEE PD CK ##/CASH DATE <br /> SITE ASSESS WKPLN 2 WORKPLAN for PERMIT ACTIVITY <br /> ASSESSMENT REPORT 3 OTHER %4RKPLN w/o PERMIT ACTIVITY 16 E <br /> ASSESS RPT w/WKPLN 4 OTHER AGENCY REPORT 17 Y �, <br /> REMED ACTION PLN (RAP) 5 LETTER 16 Ta <br /> ASSESS RPT w/RAP b PUBLIC PART mro -- 19 REVIEW FEE PO CK #/CASII DATE <br /> FINAL REMED PLN (FRP) $ s <br /> ORTLY RPT/POST REMED MONITORING 9 t <br /> STAFF REVIEW DUE: / /� OT SCHEDULED;J�f�/ OT COMPLETED: <br /> ACTION DATE ACTIONT Dr,TF, ACTION DATE <br /> ACKNOWLC/GOMMTMHT LTR RE05TD INCOMPLETE/ADDTNL INFO RECSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD PR DUE ' <br /> RWQCB C014MENTS REPORTREV1 7 Q R DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION ` FRP DUE <br /> ADDENDUM/AODTNL INFO RECVD DENIED REVISICN DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> rWORKPLA14 REVIEW COMPLETE [CftIMENT LTR SENT PROJECT CCMPLETE/lFINAL DILL <br /> EH 29 03 (PLNLOG revised 5/91) <br />