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Permit Type: Special Permi _I-s �th Agency Due <br /> Wrkpin Revw Comp CoMRedex <br /> h F'r .jest �nplt <br /> Submttal Number 93-383 Da /21/93 <br /> Site Code: 1349 <br /> Site Name: ARCO #2078 LeadAgency: <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/Operato ) <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 /> I <br /> Contact Name: Phone: <br /> Other Contact name or Info: Phone: <br /> Program Element: 3527 Billing Code: Assigned To: MM <br /> Title of Submittal: PIER <br /> =Date of Submittal: 04/15/93 OT Request: N 01 Request Date: <br /> i <br /> Type of Submittal : 3 Assessment Report <br /> Permit Fee Paid 0. 00 <br /> Check No. /Cash <br /> Date Paid <br /> i <br /> Permit Fee Paid 0. 00 j <br /> Check No. /Cash <br /> Date Paid <br /> Staff Review Due: OT Scheduled: OT Completed.- <br /> Action <br /> ompleted:Action Date Action Date Action Date ' <br /> Ack/Com Ltr Req Add. Info s d r Due <br /> Ack/Com Ltr^ Recd Revisio _ P Due <br /> RWQCB Comments ;ReR p rte. .- P.'. " -`(3; . ;^ar Due <br /> Othr Agency Appr File/ o Ac __ FRP Due <br />