Public Comment Form

Periodic Review - Template

Ecology invites you to review and comment on the periodic review for the SITE NAME/LINK site located at SITE ADDRESS.

A periodic review is conducted every five years after a cleanup action when institutional controls are used as part of the remedy, as required by the Model Toxics Control Act (MTCA). The purpose of the periodic review is to evaluate current site conditions and to ensure continued protection of human health and the environment.

Please note that this comment form is for the purpose of submitting a comment to Ecology. Commenter contact information is optional. Contact information is necessary if you want to receive future notices or responses related to this topic.


Contact Information

All fields are optional unless otherwise indicated.

Submitted by:

First Name

Last Name

Address

City/Town

State/Province

ZIP

Email

Your Comment

Comments are due by DATE
To make a comment, please enter comment(s) in the text area. To submit attachments use the "upload a file" button below. Then hit 'Continue' to review your comment(s). 
Next steps: Ecology will review comments received during the comment period and make recommendations for suggested changes.  The periodic review will become final if no significant changes are made.  An additional public comment period will be held if significant changes are made. 
Any information (e.g., personal or contact) you provide on this comment form or in an attachment may be publicly disclosed and posted on the Internet.


Cleanup Site Information

*Uploading a file is optional*
You may attach up to five 30 MB files to accompany your submission. Allowed formats are pdf, jpg, jpeg, png, txt, gif, doc, docx. If you experience technical difficulties submitting your comment please contact the person listed at the bottom of this page.


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