Extended Maintenance and Minor Repair Notification

The intent of notification and reporting is to allow the Health Department staff to know which extended maintenance and minor repair activities are occurring, give staff an opportunity to inspect the work performed, and compare electronic reports to permitted activities.

Please complete and submit the information below:

Company Name:


O&M Specialist or Installer On Site:


Phone number that you can be reached in the field:


Site Address:


Work to be performed or investigation to be conducted: 

Start Date and Time:


Stop Date and Time: