Form NOC-1 Notification of Change Form for Company Name Changes, Facility Name Changes, Permit Transfers, Ownership Changes, and/Or Operator Changes (For All Media) - Louisiana

Form NOC-1 is a Louisiana Department of Environmental Quality form also known as the "Notification Of Change Form For Company Name Changes, Facility Name Changes, Permit Transfers, Ownership Changes, And/or Operator Changes (for All Media)". The latest edition of the form was released in June 30, 2017 and is available for digital filing.

Download a PDF version of the Form NOC-1 down below or find it on Louisiana Department of Environmental Quality Forms website.

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LOUISIANA
NOTIFICATION OF CHANGE FORM (NOC-1)
FOR
COMPANY NAME CHANGES, FACILITY NAME CHANGES, PERMIT TRANSFERS,
OWNERSHIP CHANGES, AND/OR OPERATOR CHANGES (FOR ALL MEDIA)
Instructions and requirements for NOC-1 Form are located on Page 5.
NOTIFICATION OF:
Permit Transfer
Date of Transfer
Company Name Change Date of Change
Ownership Change
Date of Change
Facility Name Change
Date of Change
Operator Change
Date of Change
SITE INFORMATION
Agency Interest (AI) #
Facility Name
Location (use 911
address if applicable)
Parish
City
PERMIT INFORMATION
Please list all permit numbers regarding this facility (attach another page if necessary).
Air
Solid Waste
Water
Hazardous Waste
Biosolids
Are all permits for this AI # being transferred?
Yes
No
(If No, attach explanation)
FOR COMPANY NAME CHANGE
New Company Name
Previous Company Name
Contact Name
Contact Phone
Email
Mailing Address
City
State
Zip
form_7106_r06
NOC-1 Form
06/30/17
Page 1 of 5
LOUISIANA
NOTIFICATION OF CHANGE FORM (NOC-1)
FOR
COMPANY NAME CHANGES, FACILITY NAME CHANGES, PERMIT TRANSFERS,
OWNERSHIP CHANGES, AND/OR OPERATOR CHANGES (FOR ALL MEDIA)
Instructions and requirements for NOC-1 Form are located on Page 5.
NOTIFICATION OF:
Permit Transfer
Date of Transfer
Company Name Change Date of Change
Ownership Change
Date of Change
Facility Name Change
Date of Change
Operator Change
Date of Change
SITE INFORMATION
Agency Interest (AI) #
Facility Name
Location (use 911
address if applicable)
Parish
City
PERMIT INFORMATION
Please list all permit numbers regarding this facility (attach another page if necessary).
Air
Solid Waste
Water
Hazardous Waste
Biosolids
Are all permits for this AI # being transferred?
Yes
No
(If No, attach explanation)
FOR COMPANY NAME CHANGE
New Company Name
Previous Company Name
Contact Name
Contact Phone
Email
Mailing Address
City
State
Zip
form_7106_r06
NOC-1 Form
06/30/17
Page 1 of 5
FOR FACILITY NAME CHANGE
Previous Facility Name
New Facility Name
FOR PERMIT TRANSFERS, OWNERSHIP CHANGES, OR OPERATOR CHANGES
PREVIOUS INFORMATION
Previous Name
Previous Contact Name
Previous Contact Phone
Previous Email
Previous Mailing Address
City
State
Zip
NEW INFORMATION
New Name
New Contact Name
New Contact Phone
New Email
New Mailing Address
City
State
Zip
RESPONSIBILITY FOR EXISTING VIOLATIONS
Identify the party who will be responsible for all violations existing prior to the transfer including any potential fines for such
past violations and for all outstanding fees and assessed penalties existing prior to the transfer of the permit:
Name
Address
City
State
Zip
Signature of Previous Permit Holder
Date
Printed/Typed Name and Title
Signature of New Permit Holder
Date
Printed/Typed Name and Title
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06/30/17
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ADDENDUM TO PERMIT APPLICATIONS per LAC 33:I.1701
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 Louisiana or 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.)
Yes
No
If yes, list permits and other states below or attach another page if more space is needed.
2. Do you owe any outstanding fees or final penalties to the Department?
Yes
No
If yes, explain below or attach another page if more space is needed.
3. Is your company a corporation or limited liability company?
Yes
No
If yes, attach a copy of your company’s Certificate of Registration and/or Certificate of Good Standing from the
Louisiana Secretary of State.
PERMIT LIABILTY TRANSFER AGREEMENT
Previous Business Entity Known As
Previous Facility Name
Previous Mailing Address
City
State
Zip
Presently covered under permit(s):
Relinquishes and transfers liability, responsibility, and coverage for the permit(s) to:
New Business Entity Known As
New Facility Name
New Mailing Address
City
State
Zip
Who accepts all responsibility, coverage, and liability pertaining to permit(s) listed above upon effective transfer
occurring on:
Effective date of transfer
FINANCIAL ASSURANCE per LAC 33:I.1909.C
For Biosolids, Hazardous Waste, Solid Waste, and Water permits (regulated by the Public Service Commission) proof of
financial assurance must be provided to LDEQ.
Does the Louisiana Public Service Commission regulate this facility?
Yes
No
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CERTIFICATION
I, the undersigned certify, under provisions in Louisiana and United States law which provide criminal penalties for false
statements, that to the best of my knowledge and belief formed after reasonable inquiry, the information submitted,
including all attachments thereto are true, accurate and complete.
New Permit Liability Holder/Company Name
New Billing Address
City
State
Zip
Signature of New Responsible Official
Date
Printed/Typed Name and Title
Previous Permit Liability Holder/Company Name
Previous Billing Address
City
State
Zip
Signature of Previous Responsible Official
Date
Printed/Typed Name and Title
NOTE: If information and signatures are not obtainable from the previous owner, then the new owner must apply
for a new permit. The previous owner has the option to request termination of the existing permit.
NOTE: Instructions and requirements for NOC-1 Form are located on Page 5.
NOTE: Please see new fee amounts on Page 5.
form_7106_r06
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06/30/17
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INSTRUCTIONS AND REQUIREMENTS FOR NOC-1 FORM
FOR COMPANY NAME CHANGES, FACILITY NAME CHANGES, PERMIT TRANSFERS, OWNERSHIP CHANGES,
AND/OR OPERATOR CHANGES (FOR ALL MEDIA)
The NOC-1 form is to be submitted when a permit is transferred, a company’s name changes, a facility’s operator changes,
or a facility’s name changes in accordance with LAC 33:I. Chapter 19. Submission of this form shall in no way constitute
approval of the change request. The office will notify the requestor in writing of the decision regarding the change request. All
information must be provided. Do not leave any sections blank. Use N/A if not applicable.
1. Prior to or no later than 45 days after a change has occurred, submit one completed and signed original NOC-1
Form and one copy for each facility (Agency Interest No.). List all permits under the agency interest number for all
media. Note the different sections for permit transfers and/or company name changes or facility name changes.
The
“effective date of transfer” is the specific date of transfer of the permit responsibility, coverage, and liability between
the previous and new permittee.
2. Submit Proof of Registration with the LA Secretary of State. If your company is a corporation or a limited liability
company, attach a copy of your company’s Certificate of Registration and/or Certificate of Good Standing from the
Louisiana Secretary of State. All documents must use the company name as it is specified with the Louisiana Secretary
of State. To ensure that the proper name is on your form, please check the LA Secretary of State’s Corporation
Database at: https://coraweb.sos.la.gov/CommercialSearch/CommercialSearch.aspx.
3. Submit payment.
All payments made by check, draft, or money order shall be payable to LA Department of
Environmental Quality. For electronic funds transfer (EFT), contact the LDEQ Office of Management and Finance. For
online payments, see http://business.deq.louisiana.gov/. Submit fees as follows:
company name change, transfer,
Air Permits
per permit
$
500
ownership or operator change
company or facility name change, transfer,
per permit
none
Hazardous
ownership or operator change
Waste
Permits
Note: This form does not substitute for the HW-1 form.
company or facility name change
per permit
none
transfer, ownership or operator change:
Solid
per permit
$ 1,650
Waste
Type I, IA, II, IIA
Permits
per permit
$
413
Type III, Beneficial Use
per permit
$
125
Waste Tire Processors
company or facility name change
per permit
none
transfer, ownership or operator change:
per permit
none
general permit (LAG)
Water
Permits
10% of the calculated annual fee but not less
per permit
individual
than $ 380, excluding oyster fee
LAJ Biosolids
per permit
none
Note: Stormwater permits beginning with LAR04, LAR05 and LAR10 are not transferrable.
If you would like assistance with Notification of Changes, please contact the Permit Application Administrative Review Group
at 225-219-3292.
Completed package should be sent to:
Permits Application Administrative Review Group
Public Participation and Permit Support Division
Office of Environmental Services
LA Department of Environmental Quality
Post Office Box 4313
Baton Rouge, LA 70821-4313
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