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Responsible Party (RP): RP Address (city, state, zip): Facility Name: Facility Address (city, state, zip): County: Activity (Assessment, CAP Implementation, CAP Addendum, Abatement): ASSESSMENT How many borings/monitor wells have been installed? Has the extent of assessment directed/authorized by the TCEQ been completed? Yes No Yes No Yes No If no, explain: Are any assessment activities ongoing? If yes, directed by whom: Describe activities: Are there any proposed or necessary assessmen.

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