HazSite Orientation Session Registration Form

 Name (first and last): __________________________________________________

Company Name: ___________________________________________________________

Address: _____________________________________ P.O. Box: ________________

City: ________________________________ State: ______ Zip: _______________

Internet Email Address: _________________________________________________

Phone No.: (_____) __________________ Fax No.: (_____) __________________

Session to attend: Please indicate 1 st choice with 1. Please indicate other acceptable slots with 2 and 3.

_____Wed., Jan. 7, 1998

 8:00 - 12:00

_____Thurs., Jan. 15, 1998

 12:30 - 4:00

_____Wed., Feb. 4, 1998

 8:00 - 12:00

Please return this registration to:

New Jersey Department of Environmental Protection
Site Remediation Program
Bureau of Planning and Systems
Attention: Barbara Yuill
P.O. Box 413
Trenton, NJ 08625-0413

Last revision: 30 January 1998