Free ORDER FORM - Indiana

RISK INTEGRATED SYSTEM OF CLOSURE TECHNICAL GUIDANCE DOCUMENT AND USER'S GUIDE ORDER FORM
State Form 50389 (R / 1-07)

Approved by State Board of Accounts, 2007

1. Current copies of the Risk Integrated System of Closure (RISC) Technical Guidance Document and User's Guide are available from the Indiana Department of Environmental Management for the cost of printing. 2. The costs are: a. Technical Guidance Document $16.02, b. User's Guide Document $9.67, c. Set of Both Documents $25.69. 3. Copies may be ordered from the Indiana Department of Environmental Management by sending the order form below along with a check payable to IDEM to: Indiana Department of Environmental Management Cashier's Office ­ Mail Code 50-10C 100 N. Senate Ave. Indianapolis, IN 46204-2251 4. Purchaser's Information: NAME: ___________________________________________________________________ COMPANY: _______________________________________________________________ ADDRESS: ________________________________________________________________ __________________________________________________________________________ CITY/STATE/ZIP: __________________________________________________________ 5. Number of Documents Ordered: NUMBER OF RISC TECHNICAL GUIDANCE DOCUMENTS: _____________________ NUMBER OF RISC USER'S GUIDE DOCUMENTS: ______________________________ NUMBER OF SETS OF RISC DOCUMENTS: ____________________________________ 6. AMOUNT ENCLOSED: ____________________________________________________ Account: 6130-492000-108800