Laserfiche WebLink
SAN JOAQUINti&�WTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL h'1!F_TH DIVISION n 1991 <br /> SITE MITIGATION SUBMITTAL WR <br /> DO NOT WRITE IN THIS AREA-AGENCY USE ONLY `9 '�0SUBMITTAL LOG NUMBER <br /> GT SITE 23. kSESS- DHS / RWQCB 22. NVIRON ASSE 22.48 HER (PROG/ELEMENT PILOT PROGRAM <br /> WEEPS #/SITE CODE # Gj COMPUTER # c DATES OF SERVICE FROM _/_/_ TO <br /> LOC CODE DISTRI((CT SSIGNED Tol 1 0 `� <br /> YPE OF SUBMITTAL <br /> ESCRIPTION OF SERVICE <br /> DATE RECEIVED / / l / DATE OF SUBMITTAL y/ / / T REQUESTED ATE OT REQUESTED / lq yjj <br /> ERMIT FEE PDQ K#/CASH /`Z ATE S' EVIEW FEE PD K#/CASH /3� ATE <br /> STAFF REVIEW DUE _/_/_ ` / OT SCHEDULED _/_/_ OT COMPLETED--/-/- <br /> ACTION DATE ACTION DATE ACTION DATE <br /> CKNOWLG/COMMTMNT LTR REQSTD INCOMPLETE/ADDTNL INFO REQSTD SRP DUE <br /> CKNOWLG/COMMTMNT LTR RECVD REVISION REQSTD RR DUE <br /> WQCB COMMENTS REVIEW COMPLETE AR DUE <br /> THER AGENCY APPROVAL FILE/NO ACTION RP DUE <br /> DDENDUM/ADDTNL INFO RECVD DENIED REVISION DUE <br /> ERMIT ISSUED SPECIAL PERMIT ISSUED )THER AGENCY DUE DATE <br /> RKPLAN APPROVED COMMENT LTR SENT ILLING FORM SUBMITTED <br /> FOR AGENCY USE ONLY <br /> ee is Due: Per Unit Per Site Ha.expLanation <br /> illing emittance Amount emit Checked <br /> Program Element Date Date emitted MOUNT DUE Amount <br /> GT Corrective Action Oversight <br /> State/federal Authorized) 53.00/hr 5 hour minimum <br /> azardous Material Transmission <br /> ipeline Assessment Oversight 53.00/hr 5 hour minimum <br /> nvironmental Assessment Work Plan/ <br /> eport Review and Inspections 53.00/hr 3 hour minimum <br /> ther Government Oversight Work Plan/ <br /> Report Review and Inspections 53.00/hr 3 hour minimum <br /> eceived By ate jeceipt No. Fssuance Date IMailed <br /> PAGE TWO OF TWO <br /> EH 23074 (2/91) 89-006(VI)2/91 BILFRM128 <br />