W. Va. Code R. agency 33, tit. 33, ser. 33-22, tbl. J - Calculation of Civil Administrative Penalty Assessment
| Seriousness of Violation | ______________ |
| Negligence/Good Faith | X ______________ |
| Subtotal: | ______________ |
| Adjustment Factor | X ______________ |
| Subtotal: | ______________ |
| Unique Factor | X ______________ |
| Subtotal: | ______________ |
| History of Noncompliance | + ______________ |
| Total Assessment: | ______________ |
Notes
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