Storage Notice Details for Case No.: 00-100 Amendment No.: 0

This page shows the details for a Storage Notice Case.

APPLICANT

Applicant Name: Phone No.:
Applicant Address: Date Received:
Applicant Extra Address: Date Approved:
City/State/Zip/County: , WA     COWLITZ COUNTY Date Paid:


STORAGE FACILITY DESCRIPTION

Storage Facility Name:
Storage Facility Site Address:
Storage Facility Site Extra Address:
City/State/Zip: Kelso, WA  
The exact location of stored Asbestos Containing Material (ACM) at the facility:


PROJECT DATES

Effective Date:
Expiration Date:


SIGNATURE

Submitted By: Dated:
Email Address: Phone No.: