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I I �X i i (A"is
<br />ThnRAINVrotSIC r enwpvy nAvnn- prscnnel and vquiMvrL wry inisolved at
<br />sc� !Ia�eril irciTat RaCK OmOd ba filed w"h
<br />any If
<br />tho RAI Cffiv Of yerymcy Servions PTS) v F800 KnamVim Rode,
<br />Sn"Man y usp, cop"q, we US rmcrt I'mis viy oe mi -aired at ymm'
<br />-€ ncy. "qi'iior'
<br />rnw! Ms b"n frier of tM due of 50 wpo& -
<br />ITCA AQGY OU'
<br />notl ficatiov purvvant tit Hoalth and RfeW Code SectAn
<br />251M,7, a desigmted goyermwt ptypoy, ;MWA sign ar,d Ate Z" form in
<br />tj,..ja, bjcc!,',_ A QTmUM It", &W, not M"n taw No ilk MS 0"M
<br />t r "*' '- ific tion
<br />,o pose, a s i gn i. f i cart th t "p, hc'�I th or s a 1" �ty, , ca I I y rh""t not; a
<br />he.�n fnllowe r �liired.
<br />REPNITC1 By
<br />tol-pnono nji0cr, iind ailuress. inTcate which party you
<br />represent and jarovi&, conpany or ailency name.
<br />REP301RE PAIVY
<br />*f�__ - _F(TIPTI ione ninvibi,, contact yperson, aid aloess of the party
<br />es"nsible fm me ink, Me rawoulb'In pa4v woAd nuively bt&n U0,
<br />SITE i VA T , rfl
<br />ri^7.-r inf�nioticri r'yd rdinq to,, s,irroun.dinf3 are,1. At a
<br />Mhown ym mut ymido thfo nw�wd Full Adrusr
<br />PWAWVAG AMKH�
<br />Ev"r mvs of X_41al jymy no ReVowl Wa"r Pm!Q Cwnwl Burd
<br />'tl'i3 1 s. p'i.' �s
<br />•
<br />Move T"Mys"', o4i Tea, 'iivi�c dpt.�"" tanii ""'ix ; C�vr,"4�y ail�
<br />nlater-T'fl if'mown. Chenk box -f, ^. indica' in cd ase OF IeA-
<br />_CA W TPE
<br />typip Uopry Nw V!is to Chel one box only. Case tyDe,,
<br />is
<br />ha ed on tM wst wniom resancy afReAC For VvirriVe, if 05h Soil
<br />and grane W400- irdn' �1�',n cine: t'y'r-e wti P- "'_"3:If�d
<br />lnoicat�' oo""� "a' 1P,ifiic�;>,l )
<br />wVs nw, �nllv two aNnNA A "Nowd Tim," OwAaVn, dnw5 no-,
<br />hr """at t�'!e affec"o wo" :"No I" or q Act. Us-, or I—Ainq warn-,
<br />bi4t (;Illy 01'it YraluY 004 4"; W yo ripen 1"ntem it in UWw"Imd
<br />caw type my change won furtnor nwt0jQh-.
<br />CAUN, SPOW,
<br />ISR&T, Ouy which but &KMOS the c"Voy stats Of 50 Cue -
<br />Wal nnspox only. Me should be r ative to the tvle- For
<br />t'-:, €: is %round Woe", tMM "C"nyt StAn" sh"10 OqOl V)
<br />Up skhN of We orivand water AvestigaMon or c5amp, as O"Ond to t Of
<br />Sol.
<br />N"! P i Ai""'! � TLI:S ZCitl IS
<br />SA',:S �CAIE 0yy An IS OT 10 BE W"NHD AS HpAgVMG THE
<br />USTAL PMANN A MY WVUMVAL AUK"
<br />REEDIAL AVY1
<br />rave tveq ;sed to of or randia" the ink.
<br />Descriptions o'� Options follow:
<br />Qj";i - iuvall horizontA iliiparlrleablie layer to r,,du,(? rainfall
<br />,or!,�)jc,lvpt F3urriiFr irotall veirtkdi dike to bQck horimnUl inmewrt
<br />F
<br />lif"', rp.wo,.'< contawir.,-ftcd sAl md Asim w in npww
<br />Exc"ne and Treat ranve contaAnmed sol; and treat MN&s
<br />no
<br />fa, i,j' '),
<br />Renam Qw ProAct floatine vrodfu�ct fri�t, i,tatiir
<br />P
<br />i.lpioyod to mown
<br />q t A't
<br />uw of OV '"PAIG WhMAP tO Pmmt(�
<br />i d,- a f i,t td
<br />ly su,.pp�v tis
<br />on PCs.
<br />z'reattient rievices at p'ach or
<br />water
<br />incioent is i!6ro, ri,,,
<br />vv to POn"n vt V vpNAS of the inci&w
<br />'pr�v
<br />r:o� i)i, ,ank Sdh. or his qent. retaki too last imp-,
<br />1A
<br />E ONO"! 1,000 T"K Pere"Ng 4PKY
<br />Control 'V
<br />15weveod "aQ Auvii% P. V Box 30, Acrawrita, GA 9AW
<br />R,,,9ooaWtcr Qu,�Iltv
<br />funty Poard of Sq,er0sms or designe to rweNv ProgiosAtOn G
<br />
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