Violation Report Form

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           Violation Report Form
      U. S. Army Corps of Engineers, Charleston District             Reported To: ___________________ Date:__________
           Regulatory Division, Enforcement Branch
                                                                          Violation # __________________________________
            69-A Hagood Ave., Attn: CESAC-RD-E
           Charleston, South Carolina 29403-5107                     Assigned To: __________________________________
            1-866-329-8187, 843-329-8044, FAX 329-2332
               http://www.sac.usace.army.mil/permits                        Priority:      ____ A           ____ B          ____ C

  REPORTED BY
  U    Telephone        Name, Address, Phone Number (Unless Anonymous):                      U    Anonymous          U    DHEC-OCRM

  U    In Person                                                                             U    USACE              U    DHEC-EQC




                                                                                                                  /
  U    Written                                                                               U    USEPA              U    SCDNR




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       Surveillence                                                                               USFWS                   USDA-NRCS

  U    Other                                                                                 U                       U




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                                                                                                  USNMFS                  Other
  ALLEGED VIOLATOR(S)




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 Property Owner (Name, Address, Phone):                            Contractor or Other Parties (Name, Address, Phone):




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  LOCATION DESCRIPTION
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Nearest Municipality:                       Nearest Waterbody:                            County of Activity:
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Directions to Site:
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  ACTIVITY DESCRIPTION
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                                                                                             CESAC-CO-P, Form V-1, Revised October 24, 1997