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"0 �O <br /> SAN JOAQUIN C01#• PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAOIVISI �/JA!'y� - � <br /> NOR-LOP SITE MITIGATION/ASSESSMENT SUBMITTAL LOG '�'hL�/L <br /> SITE ADDRESSLEAD AGENCY <br /> 7 <br /> SITE CODE # 2L!)3 PROG/ELEMENT 2_/. VJO BILLING CODE ASSIGNED TO <br /> TITLE OF SUBMITTAL/:,, C/14 lik T PE CODE 3 <br /> DATE RECEIVED L1- n 2 DATE ON SUBMITTAL Y� �r 2 OT REQUEST OT REQUEST DATE <br /> PERMIT FEE PD CK #/CASH DATE REVIEW FEE PO CK #/CASH DATE STAFF REVIEW DUE: <br /> OT SCHEDULED: <br /> $ S OT COMPLETED: <br /> ACTION DATE ACTION DATE ACTION DATE <br /> ACKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REGSTD SRP DUE <br /> ACKNOWLG/COMMTMNT LTR RECVD REVISION REGSTD PR DUE <br /> RWOCS 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 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 i$265.00 <br /> ENVIRONMENTAL ASSESSMENT WORKPLN/ $53.00/ II <br /> REVIEW AND INSPECTIONS HOUR 3 HOURS $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 <br /> (monitoring/extraction/vapor Wells, EACH <br /> soil borings, vapor surveys, etc.) APPLC <br /> WELL DESTRUCTION PERMIT APPLICATION $60.00 <br /> EACH <br /> APPLC <br /> EH 29 06 (SILFRMI2 revised 5/91) <br />