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CWSRF Technical Assistance Request

Entity / Organization

LDEQ Agency Interest Number

Under an Enforcement Action / Compliance Order?

Yes No Not Yet, but will be soon

Select Status as of the date of this Request

Contact Name

Email Address

Phone Number Provide 10-digit phone number

Type of Technical Assistance Request

Managerial Technical / Operational Financial / Funding

Select All that Apply

Timeframe for Technical Assistance Needed

Select the most appropriate timeframe being requested