Assistance - Template

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Assistance ID:

Staff Assisting:

Program Type:

Contact:

Action Date:

Report

Attached Files/Reports

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
11/20/2009	Susan called and asked if they needed to do anything else with the site to get a certificate. She said the consultant removed the well. I told her nothing more needs to be done, but we do not issue certificates. I told her to get documentation of well removal from the consultant.	BILL GROSS

Assistance Details:

Field Office Compliance - Assistance