WI0400552_Staff Review Form_20200714

DIVISION OF WATER RESOURCES
REGIONAL STAFF REVIEW REQUEST FORM
Date: July 14, 2020
To: Winston-Salem Regional Office
From: Michael Rogers, Ground Water Resources Section
Telephone: [phone] E Mail. [e-mail]
A. Permit Number: WI0400552
B. Applicant: Cintas
C. Facility Name: Former RTUS/NSI Site
D. Application:
Permit Type: Groundwater Remediation Well
Project Type: New Permit
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS Staff
Report. —
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WOROS Reviewer:
COMMENTS:
NOTES: Please review with anv comments. Thanks.
Date:
FORM: WQROS-ARR ver. 3-4-2019 Page 1 of 1