Laserfiche WebLink
CORRE ONDENCE INPUT FORM - BOUNt REPORT <br /> COMPANY NAME: �,, C ` Z-7 CODE: <br /> FACILITY NAME: <br /> SITE ADDRESS: J a Q �d� d <br /> CITY: -�Gz � C Ci STAFF: <br /> COUNTY: IS J <br /> CIRCLE NUMBER AND ENTER ITEM DATE: <br /> 1 - VARIANCE PROPOSAL. . . . . . . . . . . . . . . . . <br /> 2 . - LEAK­OR PRECISION-TANK"TEST REPORT. . . <br /> 3 - INFORMAL MEETING OR PHONE CALL. . . . . . . <br /> 4 - LETTER OR MEMO. . . . . . . . . . . . . . . . . . . . . . . <br /> 5 - FORMAL MEETING. . . . . . . . . . . . . . . . . . . . . . <br /> 5 - SITE INSPECTION. . . . . . . . . . . . . . . . . . . . . <br /> 7 - ENVIRONMENTAL SITE ASSESSMENT REPORT. <br /> 8 - SOIL INVESTIGATION REPORT. . . . . . . . . . . . � <br /> 01 : <br /> PRELIMINARY REPORT. . . . . . . . . . . . . . . . . . .y �PROBLEM ASSESSMENT REPORT. . . . . . . . . . . . <br /> 11 - BEGIN REMEDIATION (REPORT) . . . . . . . . . . . <br /> 12 - CONTINUE REMEDIATION (REPORT) . . . . . . . . <br /> 13 - END REMEDIATIOfN (REPORT) . . . . . . . . . . . . .. . . . . . . . .,G/ r <br /> REPORT TITLE: i cC �,I ([0-,Zd L4u <br /> CONSULTANT: 44 / S <br /> SUMMARY:# C c — CuCc� 7 L c� - T �l <br /> ,z-tw -—Ipd is T5X <br /> 1-76q, ,.z-,— <br /> 'PRODUCT:-- COMPANY CONTACT: <br /> LEAK: PIPE/TANK/BOTH/ 2ND COMPANY: <br /> UNDETERMINED (CIRCLE ONE) <br /> ADDRESS: <br /> GW IMPACTED: YES/NO/ <br /> UNDETERMINED (CIRCLE ONE) CITY: <br /> STATE: <br /> ZIP: PHONE: <br /> *OVER FOR MEMO (Memo field in computer will be used for summaries over <br /> two lines long) . <br /> I <br /> SEE BOOR SHELF FOR BOUND REPORT <br /> I <br />