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ate'`` <br /> SAN JOAQUIN OY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL ON D VISIO( k\9q1 <br /> NON-LOP SITE MITIGATION/ASSESSMENT/SUBMITTAL LOG Qv� # <br /> SITE ADDRESS -5- <br /> Z- ' �, I /� /� LEAD AGENCY <br /> SITE CODE # 17laU I <br /> PROG/ELEMENT BILLING CODE ASSIGNED TO i <br /> TITLE OF SUBMITTAL: TYPE-CODE <br /> DATE RECEIVED DATE ON SUBMITTAL OT REQUEST OT REQUEST DATE <br /> PERMIT FEE PD SCK #/CASH DATE REVIEW FEE PD CK #/CASHDATE STAFF REVIEW DUE: <br /> OT SCHEDULED: <br /> $ �1,� �Zq C $ �� - 1 d <br /> OT COMPLETED: <br /> ACTION DATE ACTION DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REOSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REOSTD PR DUE <br /> RWQCB COMMENTS REPORT REVIEW COMPLETE PAR DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADDTNL INFO RECVD 5 DENIED REVISION DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <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 FEE RECEIVED BY # DUE <br /> UGT CORRECTIVE ACTION OVERSIGHT (CAP) $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 3 HCURS 159.00 <br /> OTHER GOVERNMENT AGENCY OVERSIGHT $53.00/ <br /> WORKPLAN/REVIEW AND INSPECTIONS HOUR 3 HOURS $159.00 <br /> BASE AMOUNT RECEIVED DATE PERMIT ISSUANCE <br /> PERMIT ACTIVITY FEES FEE RECEIVED BY # DATE <br /> WELL/BORING PERMIT APPLICATION $89.00 9 5-0 <br /> (monitoring/extraction/vapor Wells, EACH <br /> soil borings, Vapor surveys, etc.) APPLC &S_ y!� <br /> WELL DESTRUCTION PERMIT APPLICATION $60.00 <br /> EACH <br /> APPLC <br /> EH 29 06 (BILFRMI2 revised 5/91) <br />