Work Request - Template

Work Request ID:

Program Type:

Program ID:

Type:

County:

Requested By:

Due Date:

Assigned To:

Assigned Date:

Describe Request

Date	Comment	Commenter
8/4/2011	Site Survey of a new public water supply well, intended to be the source for their separate potable water. Existing wells may be cause of GWR fecal MCL's.	BOB CAMPBELL
8/11/2011	Site Survey conducted on 8/9/11.	CARL BERG

Describe Request:

Request Files

Attached Files

File Name	File Type	File Date

Action Date:

Status:

Report

Attached Files/Reports

Document Name	Type	File Date	Note
Green Plains Lakota (2011-08-09) Well Site Survey.pdf	Inspection Report (public)	08/09/2011	Site Survey

File Name	File Type	File Date	Note

Comment:

Action Type	Date	Completed Date	Comment	Delete

Field Office Compliance - Work Request