NC0026921_Facility Notification Report Form_20011219

FACILITY NOTIFICATION REPORT FORM
Date Notification Received: /2 —//
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Facility's Name & County: }
Facility NPDES Permit No.; ^� = �[o ,2/
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Person Making Notification & Phone No.: j l ' .1
Notification Taken By:
Type of Unit Out of'Operation: • Ai
Permit Limit Violations:;/
Type of Notification: 2G ?�n�� , l/�?/ .� •
Date of Field Visit:
Samples Taken:
Yes• No: t�
Field Office Actions and/or Recommendations:
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Other Sections Involved:
CC: Belinda Henson/Inspection Files
Don Register
Dale Lopez/Tx Files
Kitty Kramer/DMR files
Paul Rawls