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• Customized CERCLIS/RODS Report Order Form

Customized CERCLIS/RODS Report Order Form

Use this form to request a customized CERCLIS report, full-text Records of Decision (RODs) or any additional information on a CERCLIS site. Complete the order form, including as much information as possible. Please provide a daytime phone number so that we may contact you with any questions about your request. Write any additional comments or specific criteria for the report, such as a ROD ID number, in the box provided at the end of the order form. Click "Submit" when you have completed the form.

In what format would you like your information?
Hardcopy	Diskette	E-mail	Fax

First Name:  *
Last Name:  *
Company/Organization:
Street address:
City:
State:	select your state  Alabama  Alaska  American Samoa  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  District of Columbia  Florida  Georgia  Guam  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Majuro  Maryland  Massachusetts  Michigan  Midway  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Northern Marianas  Ohio  Oklahoma  Oregon  Pacific Islands  Pennsylvania  Puerto Rico  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Trust Territories  Utah  Vermont  Virgin Islands  Virginia  Wake Island  Washington  West Virginia  Wisconsin  Wyoming
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Daytime Phone:  *	-   -
Fax Number:	-   -
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Site Identification Information:
EPA ID Number:
Site Name:
Site Address:
City:
County:
State:	select your state  Alabama  Alaska  American Samoa  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  District of Columbia  Florida  Georgia  Guam  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Majuro  Maryland  Massachusetts  Michigan  Midway  Minnesota  Mississippi  Missouri  Montana  Navajo Nation  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Northern Marianas  Ohio  Oklahoma  Oregon  Pacific Islands  Pennsylvania  Puerto Rico  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Trust Territories  Utah  Vermont  Virgin Islands  Virginia  Wake Island  Washington  West Virginia  Wisconsin  Wyoming
Region:	1  2  3  4  5  6  7  8  9  10

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