Form RPD-35 "Norm Temporary Job-Site Notification Form" - Louisiana

What Is Form RPD-35?

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 July 1, 2008;
  • 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 RPD-35 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 RPD-35 "Norm Temporary Job-Site Notification Form" - Louisiana

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Department of Environmental Quality
Office of Environmental Compliance
Licensing & Registrations Section
P.O. Box 4312
Baton Rouge, LA 70821-4312
Phone: (225) 219-3041
Fax: (225) 219-3154
NORM TEMPORARY JOB-SITE NOTIFICATION FORM
LICENSEE PERFORMING JOB-SITE ACTIVITY
NAME:______________________________________
SPECIFIC LICENSE #:______LA-________-S01___
CONTACT PERSON:___________________________ PHONE:_(_____)_____________________________
JOB INFORMATION
NAME:______________________________________
GENERAL LICENSE #:______LA-________-N01___
CONTACT PERSON:__________________________
PHONE:_(_____)_____________________________
AI. # ______________
FACILITY NAME/DESCRIPTION_______________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
WELL SERIAL # OR FACILITY ID#_______________________
PARISH:____________________________
LOCATION/DIRECTIONS TO JOB-SITE:_________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
DESCRIBE SITE SPECIFIC ACTIVITIES:________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Remediation Only
Remediation for Unrestricted Release (must check one)
WORK START DATE:_______________________ EXPECTED COMPLETION DATE:__________________
NOTE: This form is to be used by specific licensees to notify the Division of NORM activities at temporary
jobsites.
RPD-35 (Rev. 7/08)
Department of Environmental Quality
Office of Environmental Compliance
Licensing & Registrations Section
P.O. Box 4312
Baton Rouge, LA 70821-4312
Phone: (225) 219-3041
Fax: (225) 219-3154
NORM TEMPORARY JOB-SITE NOTIFICATION FORM
LICENSEE PERFORMING JOB-SITE ACTIVITY
NAME:______________________________________
SPECIFIC LICENSE #:______LA-________-S01___
CONTACT PERSON:___________________________ PHONE:_(_____)_____________________________
JOB INFORMATION
NAME:______________________________________
GENERAL LICENSE #:______LA-________-N01___
CONTACT PERSON:__________________________
PHONE:_(_____)_____________________________
AI. # ______________
FACILITY NAME/DESCRIPTION_______________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
WELL SERIAL # OR FACILITY ID#_______________________
PARISH:____________________________
LOCATION/DIRECTIONS TO JOB-SITE:_________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
DESCRIBE SITE SPECIFIC ACTIVITIES:________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Remediation Only
Remediation for Unrestricted Release (must check one)
WORK START DATE:_______________________ EXPECTED COMPLETION DATE:__________________
NOTE: This form is to be used by specific licensees to notify the Division of NORM activities at temporary
jobsites.
RPD-35 (Rev. 7/08)