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CORRESPONDENCE ' <br /> SITE NAME. . . . . . .. . . . — — — — — — — — — — — — — — = — — (N/A if unknown) <br /> Operator Information <br /> CONTACT. . _ - - - - - - - - - - - - - - - - - - - - - - <br /> OPERATOR. - - - - - - - I - - - - - - - = - - - - - - - - - - - - - - <br /> STREET. . . - - - - - - - I - - - - - - - - - - - - - - - - - - - - - <br /> CITY. . . . . - - - - - - - ( - - - - - - - - - - - - <br /> STATE. . . . _ _ ZIP CODE. — — — — — — — — — TELEPHONE - <br /> f Complainant Contact Information, <br /> CONTACT..- <br /> OPERATOR. - - - - - - - I - - - - - - - - - - - - - - - - - - - - - - <br /> STREET. . . - - - - - - - I - - - - - - - - - - - - - - - - - - - - - - <br /> CITY. . . . . - - - - - - - - - - - - - - - -- - - - <br /> STATE. . . . ZIP CODE. I TELEPHONE <br /> COMPLIANCE REQUIREMENT <br /> PERMIT COMPLIANCE TYPE CODE. . . . . . . . . . . . P I REPORT SUBMITTAL #. .. 0 1 <br /> STATUS OF COMPLIANCE. . . . . ..,rT.. . . . . . . . A C COMPLAINT ORIGINATION. . . . <br /> SOURCE OF ORIGINATION. . . . . . . . . . .(. . . . . . . C C SUBMITTAL CATEGORY. . . . . . . . . . .-. . . . . . . . . . I E <br /> DUE DATE FOR SUBMITTALS. — — / / — FREQUENCY OF SUBMITTALS. . . . . . . . . . . . . . . . 9 9 <br /> [60 days after date of origin Itio� <br /> COMPLIANCE REQUIRMENT DESCRIPTIiN (Brief). . . . . . <br /> DESCRIPTIVE NARRATIVE PARAGRAPH:! (The Specialist is allowed 8 lines of 67 characters each, <br /> including spaces and punctuation. ) <br /> i <br /> I <br /> i <br /> I <br /> 8962F <br /> Rev 4/87 <br />