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UnUT17111 tti 1 IV, L--t,—T" CD.t!I I..k;— r—U.J-e tz;.,—U V 1113:4 I <br /> 55 <br /> Submttal Number 93-396(—) Date Received 05/03/93 <br /> Site Code ; 1,349 <br /> Site Name: ARCO #2076 Lead Agency : <br /> Address : 800 E KETTLEMAN LN Contact : <br /> City : LODI Zip: 95240 Phone : <br /> Billing/responsible Party Information <br /> Billing Name : Bill Info OK? <br /> Address .- <br /> City : State - Zip: <br /> Contact : Phone <br /> Property Owner/Operator <br /> Name ." Phone . <br /> Address : <br /> City : State : Zip: <br /> Client Information ( if different from Owner/Operator) <br /> Name : Phone : <br /> Address : <br /> City -. State : Zip. <br /> Applicant' s name, date signed, title <br /> Name : Date : <br /> Title : <br /> Consultant Company : RESNA <br /> Contact Name : Phone . <br /> Other Contact name or Info : Phone . <br /> Program Element : 3526 Billing Code; Assigned To : MM <br /> Title of Submittal : QMR <br /> Date of Submittal : 04/27/93 1 OT Request : N OT Request Date : <br /> Type of Submittal : 9 Quarterly Report/Post—Remedial Monitoring <br /> ........... <br /> Permit Fee Paid 0. 00 <br /> Check No. /Gash <br /> Date Paid <br /> Permit Fee Paid 0. 00 <br /> Check No. /Cash <br /> Date Paid <br /> Staff Review Due : OT Scheduled: OT Completed: <br /> Action Date Action Date Action Date <br /> Ack/Com Ltr Req Add. Info R st Srp Due <br /> Ack/Com Ltr Recd Revision PR Due <br /> > <br /> RWQCB Comments P <br /> - L V ar Due <br /> 'V <br /> Othr Agency Appr FilelNo c FRP Due <br /> Add. Info Recvd Denied ision Due <br /> Agency Due <br /> Permit Type -. 4ecial P. x� - a - <br />