Work Request - Template

Work Request ID - 2174

Helpful Hands - 310200796

313 S. Monroe Ave Mason City, IA 50401

Cerro Gordo County

FO 2

Site Name:

Address:

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County:

State:

Zip:

Directions:

Section:

Tier:

Range:

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Lat:

Work Request ID:

Program Type:

Program ID:

Type:

County:

Requested By:

Due Date:

Assigned To:

Assigned Date:

Describe Request

Date	Comment	Commenter
4/18/2013	ADP renewal inspection for helpful Hands Servies 17-ADP-01-02. they have stated there are no changes in their process and activities. There permit expires 5/9/2013. Kirk Johnson can be reached at 641-494-2466	SUSAN JOHNSON

Describe Request:

Request Files

Attached Files

File Name	File Type	File Date

Work Request Resolution

Action Date:

Status:

Report

Attached Files/Reports

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
4/18/2013	I had conducted an inspection approximately 30 days earlier and that was judged to have satisfied the intent of the work request.	DAVID MILLER

Comment:

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

Multiple Results Found

Field Office Compliance - Work Request

Work Request ID - 2174

Helpful Hands - 310200796

313 S. Monroe Ave Mason City, IA 50401

Cerro Gordo County

FO 2

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Facility Note

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Compliance Tracking