NC0021504_Facility Notification Form_20010206

Date Notification Received:
Facility's Name & County:
Facility NPDES Permit No.;
Person Making Notification &• Phone No.:
Notification Taken By:
Type of Unit Out of Operation:
Permit Limit Violations:
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Type of Notification:
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Date of Field Visit:
Samples Taken: Yes: No•
Field Office Actions and/or Recommendations:
Other Sections Involved•
CC: Belinda Henson/Inspection Files
won Register
Dale Lopez/Tx Files
Kitty Kramer/DMR files
Paul Rawls