NOTICE OF VIOLATION RESPONSE FORM We do not contest

							                  NOTICE OF VIOLATION RESPONSE FORM

                This form is to be completed and returned within 30 days

RE: NOV#                                                   Date:

                                                           Phone:


Person with authorization completing this form:

Title:



         We do not contest the Notice of Violation.

         We do contest the Notice of Violation and request to appear
         before the Hearing Officer. We are contesting:

             Penalty
             Facts

Mark all that apply. If the facts are being contested, please provide a written detailed
explanation of your reason for contesting the fact(s) and include any supporting
documentation with this form. This information will be given to the Hearing Officer prior
to the hearing.


Comments:




Please mail the completed form to Carol Starczewski or Pam Green at: Clark County
Department of Air Quality & Environmental Management, 500 S. Grand Central Parkway,
Las Vegas, NV 89155. Or, you may fax to (702) 455-1537.