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ENFORCEMENT MAQdTENANCE CODWG FORM <br />~ _ q~-o~~ <br />*PERMIT NO: C~ Q ~ -QO Z <br />INFRACT/ON NO: CV-__-__ <br />INSPECTION DATE: <br />INSPECTION TIME: ~_ <br />VACATION OF NOV DATE: / / <br />VIOLATION MODIFICATION (DATE: / / <br />VIOLATION MODIFICATION 2 DATE: / / <br />VIOLATION MODIFICA"iION 3 DATE: <br />ABATEMENTS: #l <br />DATE DUE: 5-~ 15A~ <br />/ / <br />#2 <br />EXTENDED DATE: _ _I _ _i_ _ <br />INFRACTED DATE: i i <br />DOCUMENTS: <br />Proposed Civil Penalty ~ <br />a$Civil Penalty Worksheet ~- <br />Posting Notice Assesstnen[ Conference <br />Settlement Agreement <br />Notice & Order to Pay Fixed Penalty <br />Notice of Vacation of NOV <br />WSPECTOR INITIALS: v~ <br />DATE ISSUED: 3 -5'q~S <br />INFRACTION CATEGORY: <br />PRIMARY TOPIC: <br />SECONDARY TOPIC: <br />TERTIARY TOPIC: <br />--~--~-- <br />- -~- -~- - <br />#3 <br />--I--I-- <br />- -~- -~- - <br />'This Form will he swirled by the DP person and put in specialist file. <br />~ These forms will be generated and put in Fle for use by Senior EPS in penalty assessment. <br />**This Form will fie used in cunjunction with the other NOV forms. <br />••This Form is to be routed between DP person & Specialist until the NOV is completely finished with. <br />#4 <br />--~--t-- <br />- -~- -~- - <br />conl~ShareVorms~cM ing9. rrm <br />