Stormwater Pollution Prevention Plan - Phoenix Sky Harbor ...

AIRFIELD DRIVER PERMIT
NUMBER
DATE OF INSURANCE
MO/ DAY/ YEAR:
NOTICE OF STORM WATER VIOLATION
DATE OF VIOLATION
MO/ DAY/ YEAR:
TIME
NOTICE NO.
VIOLATOR’S NAME
VIOLATOR’S EMPLOYER
EMPLOYER’S ADDRESS
TENANT TO WHOM CONTRACTED (If Applicable)
VEHICLE I.D. NO/LICENSE PLATE
DESCRIPTION OF VIOLATION
IDENTIFY FAULTY EQUIPMENT
(IF APPLICABLE)
LOCATION OF VIOLATION
VIOLATOR’S NAME (PRINT)
DEPT./DIV.
VIOLATOR’S SIGNATURE VIOLATOR’S SUPERVISOR TELEPHONE
NO.
ISSUEDD BY
TITLE:
WRITTEN REPORT DUE WITHIN 15 DAYS – SEE ACCOMPANYING INSTRUCTIONS
**NOTE: Supervisor/Manager must acknowledge receipt of the Notice of Violation by calling 273-8861 and leave a message
within 24 hours
Revised 4/22/99 -8-