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Get OH Oil and Gas Development Public Safety Coordination Form

De: / / Longitude: Well Site Address: ( TO BE ASSIGNED BY LOCAL ADDRESSING OFFICAL FOR 911 USE) State/County/Twp. Road for Well Site Access Road Latitude: Longitude: Cross-Roads Nearest to Well Site Access Road: Transportation Routes for Well Site: (As determined by County Engineer or Local Official) II. Company Emergency Contact Information: (To be filled out by Company) Company Name: 24 Hour Contact Number: Local Company Contact/Title: Email: Phone: Cell: III. Local Emergency Respo.

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