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SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH SIV[ION <br /> NON-LOP SITE MITIGATION/ASSESSMENT SUBMITTAL LOGQQ <br /> �7�� #I. 3 <br /> y A SITE ADDRESS , LEAD AGENCY <br /> SITE CODE G 1 3k34 PROG/ELEMENT 5.1 . BILLING CODE JASSIGNED TO y <br /> TITLE OF SUBMITTALS �kV: TYPE CODE <br /> DATE RECEIVED <br /> DATE Ohfi SusMITTAi OT REQUEST OT REQUEST DATE <br /> PERMIT FEEPDCK WCASH DATE REVIEW FEE PD CK #/ SHS DATE STAFF REVIEW DUE: <br /> OT SCHEDULED <br /> E �.VV r.Q $ _""• �}" ll/ OT COMPLETED: <br /> FACTION DATE ACTION AUG A ACTION DATE <br /> ACKNOWLS/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL 140 RE09TO �/ /SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REQSTO PR DUE <br /> Rwom 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 ISSUEDW !� SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> 9-3-91 <br /> WORKPLAN .REVIEW COMPLETE COMMENT LTR SENT PROJECT COMPLETE/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 FEERECEIVED BY # DUB <br /> UGT CORRECTIVE ACTION 01fZ:R51G9T (CAPy $53.00/ <br /> - HOUR 5 HOURS $265.00 <br /> HAZARDOUS MATERIAL TRANSMISSION $53.00/ <br /> PIPELINE ASSESSMENT OVERSIGHT HOUR 5 HOURS $265.00 <br /> ENVIRONMENTAL ASSESSMENT WORKPLN/ $53.00/ <br /> REVIEW AND INSPECTIONS HOUR 1.3 HOURS $159.00 I <br /> OTHER GOVERNMENT AGENCY OVERSIGHT 553,00/ <br /> WORKPLAN/IIEVIEW AND INSPECTIONS HOUR , 3 HOURS $159.00 <br /> BASE . AMOUNT RECEIVED DATE PERMIT ISSUANCE <br /> PERMIT ACTIVITY.FEES FEE. RECEIVED BY # . . DATE <br /> WELL/BORIK-PERMIT APPLICATION <br /> (monitoring/extraction/vepor welts, EACH <br /> soft borings, vapor.,survoys, etc.).,. ,.. . APPLC Vwlj <br /> 4 <br /> WELL DESTRUCTION PERMIT APPLICATION $60.00 <br /> EACH <br /> APPLC <br /> c <br /> ER 29 06 (BILFRMI2 revised 5/91) } r' <br />