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SAN JOAQUIN COUNTY • PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH D M S <br /> SITE MITIGATIONIASSESSMENT SUBMITTAL LOG # <br /> SITE ADDRESS 1 LEAD AGENCY <br /> AGENCY CONTACT.. <br /> CONSULTANT CO ' <br /> PHONE W AREA CD <br /> CONTACT NAME PHONE ] <br /> OTHER CONTACT NAME or INFO /! (G' �a PHONE <br /> SITE CODE # PROG/ELEMENT 2 l 81LLING CODE ASSIGNED TO'' ��'` ►�'`�« . <br /> TITLE OF SUBMITTAL: <br /> DATE RECEIVED DATE ON SUBMITTAL OT REQUEST OT REQUEST DATE 4, 4 2j A <br /> TYPE OF SUI&ITTAt CODE TYPE 0 SUBM TAL CODE <br /> RE-EXCAVATION WKPLN 1 PERMIT APPLICATION W/o WRKPLN 10 PERMIT FEE PD CK #!CASH DATE <br /> SITE ASSESS WKPLN 2 WORKPLAN for PERMIT ACTIVITY 11 S <br /> ASSESSMENT REPORT 3 OTHER WRKPLN w/o PERMIT ACTIVITY 16 S <br /> ASSESS RPT w/WKPLN 4 OTHER AGENCY REPORT 17 S <br /> REMED ACTION PLN (RAP) 5 LETTER 18 S <br /> ASSESS RPT w/RAP 6 PUBLIC PART INFO 14 REVIEW FEE PD CK #/CASH DATE <br /> FINAL REMED PLN (FRP) 8 S <br /> QRTLY RPT/POST REMED MONITORING Fq) <br /> $ <br /> STAFF REVIEW DUE: ,!/ OT SCHEDULED: J. ^!� OT COMPLETED: ,!__I_ <br /> ACTION DATE ACTION DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCCMPLETE/ADDTNL.INFO REQSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REOSTD PR DUE <br /> RWQCB COMMENTS �-REPORT`R " ETE yP DUE <br /> OTHER AGENCY APPROVAL FILE/NO ACTION FRP DUE <br /> ADDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> PERMIT ISSUED W / B SPECIAL PERMIT ISSUED OTHER AGENCY DUE DATE <br /> WORKPLAN REVIEW COMPLETE COMMENT LTR,.SENT PROJECT CCMPLETE/FINAL' BILL <br /> EH 29 03 (PLNLOG revised 5/41) <br />