ADEM Form 34 (ADEM-eDWRS-1A) "Lab Registration Form" - Alabama

What Is ADEM Form 34 (ADEM-eDWRS-1A)?

This is a legal form that was released by the Alabama Department of Environmental Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2014;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of ADEM Form 34 (ADEM-eDWRS-1A) by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

ADVERTISEMENT
ADVERTISEMENT

Download ADEM Form 34 (ADEM-eDWRS-1A) "Lab Registration Form" - Alabama

Download PDF

Fill PDF online

Rate (4.5 / 5) 68 votes
Form ADEM-eDWRS-1A
B. Form ADEM-eDWRS-1A: Lab Registration Form
INSTRUCTIONS: Lab Responsible Officials (LRO) must complete this form to register a Lab for
electronic reporting and request access to the eDWRS for authorized Lab personnel to assign them a role
of preparer or certifier. NOTE: A completed Form ADEM-eDWRS-2 is required for every user with a
role of certifier. Do Not email the documents to ADEM. Access for a certifier will not be provided until
the documents with original signatures are received.
Part A: Lab Information
Lab Number:
Lab Name:
Street:
Mailing Address:
City:
State:
Zip:
New Application
Manage Account Information
Request for Reactivation
Part B: Lab User Account Information (All fields are required.)
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
ADEM Form 34 5/14
1-B
Form ADEM-eDWRS-1A
B. Form ADEM-eDWRS-1A: Lab Registration Form
INSTRUCTIONS: Lab Responsible Officials (LRO) must complete this form to register a Lab for
electronic reporting and request access to the eDWRS for authorized Lab personnel to assign them a role
of preparer or certifier. NOTE: A completed Form ADEM-eDWRS-2 is required for every user with a
role of certifier. Do Not email the documents to ADEM. Access for a certifier will not be provided until
the documents with original signatures are received.
Part A: Lab Information
Lab Number:
Lab Name:
Street:
Mailing Address:
City:
State:
Zip:
New Application
Manage Account Information
Request for Reactivation
Part B: Lab User Account Information (All fields are required.)
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
ADEM Form 34 5/14
1-B
Form ADEM-eDWRS-1A
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
Account Action:
User Role:
Add
Update
Remove
Preparer
Certifier
General Information
Last Name:
First Name:
Middle Name/Initial:
Job Title:
Employer’s Name:
Contact Information
E-mail:
Street:
Mailing Address:
City, State, Zip:
Phone Number(s):
ADEM Form 34
2-B
Form ADEM-eDWRS-1A
Part C: Permittee Registration
I request that the above identified Lab be registered for electronic reporting to allow the use of the
ADEM eDWRS.
Please establish or revise the above user accounts in accordance with the information provided for
each identified Lab User. The users who are designated to be a Certifier are Authorized Lab
Representatives for this Lab for all reporting purposes. I understand that all Authorized Lab
Representatives must submit an original completed Form ADEM-eDWRS-2: Terms and Conditions
Agreement.
I certify under penalty of law that I have personally examined and am familiar with the information
submitted in this application and all attachments and that, based on my inquiry of those persons
immediately responsible for obtaining the information contained in the application, I believe that the
information is true, accurate and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment.
LRO Name (type or print)
LRO Signature
Date
LRO Title (type or print)
For Office Use Only:
Name
Date
Received by:
Approved by:
ADEM Form 34
3-B
Page of 3