760003_Complaint_20180821

CALL and COMPLAINT LOG
Division of Water Resources - Animal Waste
Winston-Salem Regional Office
Date Received: $- 2-1-
Time Received: I PM
Staff Receiving call: e_ b O <_
0
Facility Name:
Permit Number: (D 3
Contact Name:
Contact Phone/Email:
Comments/Description:
Follow-up Required: Yes or(9
Date and Type of Inspection(s) Conducted:
Result of Complaint Investigation:
Date Investigation Began:
Date Investigation Closed:
Was a violation documented? Yes or No
Responsible Party:
Address: