DEQ-CFW_00034469

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azardous Waste Compliance Data Entry Form — Side A
Facility Name:
EPA ID Number:
Location:
- Ji�� -
ES'ALUATION DATA New: ✓ Change: Delete:
Map. Day Yr. Type:
Date: t 11 /,�l r k,,
Inspector ID #: 6S Reason: FINANCIAL RESPONSIBILITY
Evaluation Comments:
Type: Date Determined / �1 Class:
Priority: _ Branch:-- Person:
Return to Compliance 1 �/ _ _1
*scheduled* *Actual*
Reg. Type:
Reg. Description:
Comment:
DEQ-CFW 00034469