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[]
[null,null,null,"REQUEST FOR CONDUCTING OF"]
[null,null,null,"MINI-SID, CROSS HOLE SONIC LOGGING (CSL)"]
[null,null,null,"CULVERT OR DOWN HOLE CAMERA INSPECTIONS"]
[]
[null,"Authorization Number:"]
[null,"State Project Number:"]
[null,"Federal Project Number:"]
[null,"County:"]
[null,"District:"]
[null,"Project Name:"]
[]
[null,"Testing Required:",null,null,"Mini-Sid",null,null,"CSL"]
[null,null,null,null,"Culvert",null,null,"Down Hole"]
[null,null,null,null,"Inspection",null,null,"Inspection"]
[]
[null,"Requested Inspection Date:"]
[]
[null,null,null,null,"Names",null,null,"Phone:"]
[null,"Project Supervisor:"]
[null,"Contact Person:"]
[]
[null,"Direction to Site:"]
[]
[]
[null,"Specifications:"]
[]
[null,"Item information:"]
[null,null,null,null,"Diameter",null,null,"Depth, Length"]
[null,null,"Caisson"]
[null,null,"Culvert"]
[null,null,"Hole"]
[]
[null,"Please fax or Mail"]
[null,"the Following Items:",null,null,"Location Map"]
[]
[null,"Fax Number",null,null,"304 558-0253"]
[null,"Address:",null,null,"190 Dry Branch Drive"]
[null,null,null,null,"Charleston, WV  25306"]
[]
[null,null,"For:",null,"Email this form to:"]
[null,null,"Mini-Sid",null,"Edward.J.Sizemore@wv.gov"]
[null,null,"CSL",null,"Edward.J.Sizemore@wv.gov"]
[null,null,"Culvert",null,"Steve.O.Marshall@wv.gov"]
[null,null,"Down Hole",null,"Steve.O.Marshall@wv.gov"]
[]
[null,"Please send a copy to:",null,null,"Roy.J.Capper@wv.gov"]

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