Form 7037 "Addendum to Permit Applications Per Lac 33:i.1701" - Louisiana

What Is Form 7037?

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

Form Details:

  • Released on January 1, 2006;
  • The latest edition provided by the Louisiana Department of Environmental Quality;
  • 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 printable version of Form 7037 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Environmental Quality.

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Download Form 7037 "Addendum to Permit Applications Per Lac 33:i.1701" - Louisiana

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LOUISIANA DEPARTMENT OF ENVIRONMENTAL QUALITY
Addendum to Permit Applications per LAC 33:I.1701
Introduction
This Addendum to Permit Applications provides
Step-by-Step Instructions
information to the Permits Division which is used to
1 Media Type
comply with the requirements of LAC 33:I.1701 –
Indicate whether this is for a Solid Waste, Air, Water,
Requirements for Obtaining a Permit. Authority to ask
Hazardous Waste or Radiation Licensing application.
for this information is contained in the Louisiana
Administrative Code, Title 33. Copies of this law are
2 Agency Interest Number
available from the Regulation Development Section of
If blank, type or print the Agency Interest Number in the
the Office of Environmental Assessment, or on the
space provided at the top of each page (if known);
Internet at:
otherwise, leave blank.
http://www.ldeq.org/planning/regs/title33/index.htm
3 Indicate if Copy of Previously Submitted Form
Who Should Submit an Addendum to Permit
Indicate whether or not this is a copy of a previously
Applications?
submitted form. If yes, indicate the original submittal
The Addendum to Permit Applications should be
date and the permit number for which it was previously
submitted for any permit application submitted for a new
submitted. You may not submit a copy which has an
source and for all permit actions, including renewals
original signature date that is more than twelve months
and changes of ownership.
Air permit modification
old.
requests are exempt from this requirement unless they
include, or are limited to, a change of ownership.
4 Company Name, Parent Company, Plant Name
and Location
What If I Previously Sent an Addendum to Permit
If blank, type or print the name of the company, the
Applications to DEQ?
name of its parent, the name of the plant, if any, the
You must submit this addendum with each permit
parish where the plant is located, and the closest town
application, as stated above. It is acceptable to submit
in the same parish as the facility.
Check the
a copy of a previously submitted form, if the original
appropriate box to indicate if the permittee is the owner
signature date is not more than twelve months old.
or operator of the facility.
Indicate the original submittal date and the permit
number for which it was previously submitted. Please
5 List of States With Similar Actions
review the information to ensure that it is still correct.
Please provide a list of the states where you, as
applicant, have federal or state environmental permits
What You Should Submit and What You Should
identical to, or of a similar nature to, the permit for
Keep
which you are applying.
Route the original and two photocopies to this agency.
For Part 70 Air Permit applications, a copy should be
6 Outstanding Fees
submitted directly to EPA's Dallas office -- EPA Region
Do you owe any outstanding fees or final penalties to
6 (6PD-R), 1445 Ross Avenue, Suite. 1200, Dallas TX
the Department? If so, please explain.
75202-2733.
7 Registration with Secretary of State
Acceptable Answers
If your company is a corporation or a limited liability
“NA” is not an acceptable answer. If a particular section
company, please provide proof of registration with the
does not apply to you, explain why. Please attach
Secretary of State.
additional sheets for the required information. The
Department may require the submission of additional
8 Responsible Official
information if it deems such information necessary.
Enter the name, address, and phone number of the
responsible company official. Part 70 sources must
General
meet the requirements of LAC 33.III.502 regarding the
Do not write information in the top or left side margin of
Responsible Official.
this form as file folder bindings may cover the
information.
9 Certification by Responsible Official
An authorized company agent should sign and date the form
confirming its accuracy and completeness.
form_7037_r03
1/1/06
LOUISIANA DEPARTMENT OF ENVIRONMENTAL QUALITY
Addendum to Permit Applications per LAC 33:I.1701
Introduction
This Addendum to Permit Applications provides
Step-by-Step Instructions
information to the Permits Division which is used to
1 Media Type
comply with the requirements of LAC 33:I.1701 –
Indicate whether this is for a Solid Waste, Air, Water,
Requirements for Obtaining a Permit. Authority to ask
Hazardous Waste or Radiation Licensing application.
for this information is contained in the Louisiana
Administrative Code, Title 33. Copies of this law are
2 Agency Interest Number
available from the Regulation Development Section of
If blank, type or print the Agency Interest Number in the
the Office of Environmental Assessment, or on the
space provided at the top of each page (if known);
Internet at:
otherwise, leave blank.
http://www.ldeq.org/planning/regs/title33/index.htm
3 Indicate if Copy of Previously Submitted Form
Who Should Submit an Addendum to Permit
Indicate whether or not this is a copy of a previously
Applications?
submitted form. If yes, indicate the original submittal
The Addendum to Permit Applications should be
date and the permit number for which it was previously
submitted for any permit application submitted for a new
submitted. You may not submit a copy which has an
source and for all permit actions, including renewals
original signature date that is more than twelve months
and changes of ownership.
Air permit modification
old.
requests are exempt from this requirement unless they
include, or are limited to, a change of ownership.
4 Company Name, Parent Company, Plant Name
and Location
What If I Previously Sent an Addendum to Permit
If blank, type or print the name of the company, the
Applications to DEQ?
name of its parent, the name of the plant, if any, the
You must submit this addendum with each permit
parish where the plant is located, and the closest town
application, as stated above. It is acceptable to submit
in the same parish as the facility.
Check the
a copy of a previously submitted form, if the original
appropriate box to indicate if the permittee is the owner
signature date is not more than twelve months old.
or operator of the facility.
Indicate the original submittal date and the permit
number for which it was previously submitted. Please
5 List of States With Similar Actions
review the information to ensure that it is still correct.
Please provide a list of the states where you, as
applicant, have federal or state environmental permits
What You Should Submit and What You Should
identical to, or of a similar nature to, the permit for
Keep
which you are applying.
Route the original and two photocopies to this agency.
For Part 70 Air Permit applications, a copy should be
6 Outstanding Fees
submitted directly to EPA's Dallas office -- EPA Region
Do you owe any outstanding fees or final penalties to
6 (6PD-R), 1445 Ross Avenue, Suite. 1200, Dallas TX
the Department? If so, please explain.
75202-2733.
7 Registration with Secretary of State
Acceptable Answers
If your company is a corporation or a limited liability
“NA” is not an acceptable answer. If a particular section
company, please provide proof of registration with the
does not apply to you, explain why. Please attach
Secretary of State.
additional sheets for the required information. The
Department may require the submission of additional
8 Responsible Official
information if it deems such information necessary.
Enter the name, address, and phone number of the
responsible company official. Part 70 sources must
General
meet the requirements of LAC 33.III.502 regarding the
Do not write information in the top or left side margin of
Responsible Official.
this form as file folder bindings may cover the
information.
9 Certification by Responsible Official
An authorized company agent should sign and date the form
confirming its accuracy and completeness.
form_7037_r03
1/1/06
Media Type (check one)
Agency Interest Number:
Hazardous Waste
Air
Is this a copy of a previously submitted form? Yes
No
Solid Waste
Water
If yes, indicate the original submittal date:
Radiation Licensing
If yes, indicate the original permit number:
Department of Environmental Quality
Addendum to Permit Applications
Permits Division
P.O. Box 4312
per
Baton Rouge, LA 70821-4312
LAC 33:I.1701
(225) 219-3041
For Permits Division Use Only
Please
Company Name
Owner
Type
Operator
Or
Print
Parent Company (if Company Name given above is a division)
Plant name (if any)
Nearest town
Parish where located
1. Does the company or owner have federal or state environmental permits identical to, or of a similar
nature to, the permit for which you are applying in other states? (This requirement applies to all
individuals, partnerships, corporations, or other entities who own a controlling interest of 50% or
more in your company, or who participate in the environmental management of the facility for an
entity applying for the permit or an ownership interest in the permit.)
Permits in Louisiana. List Permit Numbers:
Permits in other states (list states):
2. Do you owe any outstanding fees or final penalties to the Department? No
Yes
If yes, please explain.
3. Is your company a corporation or limited liability company? No
Yes
If yes, attach a copy of
your company’s Certificate of Registration and/or Certificate of Good Standing from the Secretary of
State.
Certification:
I certify, under provisions in Louisiana and United States law which provide criminal penalties for false
statements, that based on information and belief formed after reasonable inquiry, the statements and
information contained in this Addendum to the Permit Application, including all attachments thereto are
true, accurate, and complete.
Responsible Official
Name
City
State
Zip
Title
Business phone
Company
Signature of responsible official(s)
Suite, mail drop, or division
Date
Street or P.O. Box
form_7037_r03
1/1/06
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