Form 7264_R02 "Sewage Sludge & Biosolids Use or Disposal Reporting Form for Sewage Sludge Pumped out or Removed From a Sanitary Wastewater Treatment Works and Sold, Given Away, and/or Hauled off-Site for a Fee or Other Consideration" - Louisiana

Form 7264_R02 or the "Sewage Sludge & Biosolids Use Or Disposal Reporting Form For Sewage Sludge Pumped Out Or Removed From A Sanitary Wastewater Treatment Works And Sold, Given Away, And/or Hauled Off-site For A Fee Or Other Consideration" is a form issued by the Louisiana Department of Environmental Quality.

The form was last revised in March 7, 2017 and is available for digital filing. Download an up-to-date Form 7264_R02 in PDF-format down below or look it up on the Louisiana Department of Environmental Quality Forms website.

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Download Form 7264_R02 "Sewage Sludge & Biosolids Use or Disposal Reporting Form for Sewage Sludge Pumped out or Removed From a Sanitary Wastewater Treatment Works and Sold, Given Away, and/or Hauled off-Site for a Fee or Other Consideration" - Louisiana

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SEWAGE SLUDGE & BIOSOLIDS USE OR DISPOSAL REPORTING FORM
FOR
SEWAGE SLUDGE PUMPED OUT OR REMOVED FROM A SANITARY WASTEWATER TREATMENT
WORKS AND SOLD, GIVEN AWAY, AND/OR HAULED OFF-SITE FOR A FEE OR OTHER
CONSIDERATION
[N
: A separate form must be filled out if your Use or Disposal Option is: (1) Disposers of Sewage Sludge (2)
OTE
Land Application (3) Receivers of Sewage Sludge From Outside Sources or (4) Incineration]
NOTE: The reporting requirement is on an Annual Basis. The form must be filled out with information to completely
st
st
cover the previous year’s activities (January 1
– December 31
) and submitted to:
Louisiana Department of Environmental Quality
Office of Environmental Services
Water Permits Division
Post Office Box 4313
Baton Rouge, Louisiana 70821-4313
Legal Company/Facility Name:
Contact Person:
Permit #:
Contact Phone #:
Agency Interest (AI) #:
(1) Date of Report: _______________________________________
(2) Reporting Period: From: __________________________ To: ________________________________
(3) Information Regarding the Pumper/Hauler/Transporter that removed Sewage Sludge from your Facility (If
necessary, add additional sheets.):
Name of
Pumper/Hauler/Transporter
Contact Phone
Gallons/Yr
Tons/Yr
Address
or Facility That Removed the
Number
Removed
Removed
Sewage Sludge
(4) Certification Statement:
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gathered and evaluated the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information,
the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the
possibility of a fine and imprisonment for knowing violations.
Signature: ______________________________________
Date Signed: _______________________________
Printed Name:
Email:
**THIS FORM WILL NOT BE ACCEPTED WITHOUT AN ORIGINAL SIGNATURE.**
Form_7264_r02
03/07/2017
SEWAGE SLUDGE & BIOSOLIDS USE OR DISPOSAL REPORTING FORM
FOR
SEWAGE SLUDGE PUMPED OUT OR REMOVED FROM A SANITARY WASTEWATER TREATMENT
WORKS AND SOLD, GIVEN AWAY, AND/OR HAULED OFF-SITE FOR A FEE OR OTHER
CONSIDERATION
[N
: A separate form must be filled out if your Use or Disposal Option is: (1) Disposers of Sewage Sludge (2)
OTE
Land Application (3) Receivers of Sewage Sludge From Outside Sources or (4) Incineration]
NOTE: The reporting requirement is on an Annual Basis. The form must be filled out with information to completely
st
st
cover the previous year’s activities (January 1
– December 31
) and submitted to:
Louisiana Department of Environmental Quality
Office of Environmental Services
Water Permits Division
Post Office Box 4313
Baton Rouge, Louisiana 70821-4313
Legal Company/Facility Name:
Contact Person:
Permit #:
Contact Phone #:
Agency Interest (AI) #:
(1) Date of Report: _______________________________________
(2) Reporting Period: From: __________________________ To: ________________________________
(3) Information Regarding the Pumper/Hauler/Transporter that removed Sewage Sludge from your Facility (If
necessary, add additional sheets.):
Name of
Pumper/Hauler/Transporter
Contact Phone
Gallons/Yr
Tons/Yr
Address
or Facility That Removed the
Number
Removed
Removed
Sewage Sludge
(4) Certification Statement:
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gathered and evaluated the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information,
the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the
possibility of a fine and imprisonment for knowing violations.
Signature: ______________________________________
Date Signed: _______________________________
Printed Name:
Email:
**THIS FORM WILL NOT BE ACCEPTED WITHOUT AN ORIGINAL SIGNATURE.**
Form_7264_r02
03/07/2017
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