Form UST-CC-2 "Application for Ust Continuing Education Course Approval" - Louisiana

What Is Form UST-CC-2?

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 August 24, 2001;
  • 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;

Download a printable version of Form UST-CC-2 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 UST-CC-2 "Application for Ust Continuing Education Course Approval" - Louisiana

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APPLICATION FOR UNDERGROUND STORAGE TANK
CONTINUING EDUCATION COURSE APPROVAL
Please print or type
Return To: Louisiana Department of Environmental Quality
Solid and Hazardous Waste Permits Section
Date Received _______________________
P. O. Box 4313
Reviewed By ________________________
Baton Rouge, LA. 70821-4313
A. IDENTIFYING INFORMATION
Name of Training Provider
E-Mail Address:
Title of Course
Mailing Address (Street Name & Number, P. O. Box or Rural Route and Box Number)
State
Zip Code
City/Town
(
)
(
)
Name of Person to Contact Regarding Application
Telephone Number
Fax Number
B. CATEGORY OF TRAINING COURSE
___
Installation/Repair
____ Closure
____ Installation/Repair/Closure
C. TRAINING COURSE CERTIFICATES
Attach a sample of the certificate that will be issued to persons completing the training course. All certificates
must include:
1. A space for the course number issued by the Louisiana Department of Environmental Quality (LDEQ);
2. A space for the participant's name and LDEQ certification number;
3. The number of hours to be credited to participant; and
4. The date and location of the training course.
D. DATES, TIMES AND LOCATIONS OF COURSE
Provide the proposed dates, times and locations of the course addressed in this application.
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
E. COURSE CREDIT HOURS
Indicate the total number of credit hours being requested for this course
F. CERTIFICATION
I certify that the technology or methods that will be presented in the training course addressed in this application, and
all attachments will satisfy the Louisiana Department of Environmental Quality rules, and state and federal laws
governing the installation, repair or closure of underground storage tanks.
Signature
Date
Name and Title of Person Authorized to Sign for Organization
UST-CC-2
Page One of Three
REVISED AUGUST 24, 2001
APPLICATION FOR UNDERGROUND STORAGE TANK
CONTINUING EDUCATION COURSE APPROVAL
Please print or type
Return To: Louisiana Department of Environmental Quality
Solid and Hazardous Waste Permits Section
Date Received _______________________
P. O. Box 4313
Reviewed By ________________________
Baton Rouge, LA. 70821-4313
A. IDENTIFYING INFORMATION
Name of Training Provider
E-Mail Address:
Title of Course
Mailing Address (Street Name & Number, P. O. Box or Rural Route and Box Number)
State
Zip Code
City/Town
(
)
(
)
Name of Person to Contact Regarding Application
Telephone Number
Fax Number
B. CATEGORY OF TRAINING COURSE
___
Installation/Repair
____ Closure
____ Installation/Repair/Closure
C. TRAINING COURSE CERTIFICATES
Attach a sample of the certificate that will be issued to persons completing the training course. All certificates
must include:
1. A space for the course number issued by the Louisiana Department of Environmental Quality (LDEQ);
2. A space for the participant's name and LDEQ certification number;
3. The number of hours to be credited to participant; and
4. The date and location of the training course.
D. DATES, TIMES AND LOCATIONS OF COURSE
Provide the proposed dates, times and locations of the course addressed in this application.
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
Date (Month Day & Year)
Time (Start to Finish)
Location (City)
E. COURSE CREDIT HOURS
Indicate the total number of credit hours being requested for this course
F. CERTIFICATION
I certify that the technology or methods that will be presented in the training course addressed in this application, and
all attachments will satisfy the Louisiana Department of Environmental Quality rules, and state and federal laws
governing the installation, repair or closure of underground storage tanks.
Signature
Date
Name and Title of Person Authorized to Sign for Organization
UST-CC-2
Page One of Three
REVISED AUGUST 24, 2001
Application for Underground Storage Tank Continuing Education Course Approval
Page Two of Three
G. VERIFICATION OF ATTENDANCE
Describe the method to be used to verify participant's attendance at all sessions of the training course. Attach
documents to be used for this purpose.
H. COURSE INSTRUCTORS
Provide the name(s) of the individual(s) that will be instructing the training course and list their
credentials
Instructor Name
Credentials
Instructor Name
Credentials
Instructor Name
Credentials
Instructor Name
Credentials
Application for Underground Storage Tank Continuing Education Course Approval
Page Three of Three
I. COURSE SESSIONS
Complete the information below for each session. If you cannot list all sessions on this application, you may use a supplementary sheet.
Attach copies of all documents to be distributed to persons attending the course.
Session Topic
Description of Information To Be Presented In Session
Training Material To Be Used
(list all reference documents, films, etc., to be used)
Time Allotted for Session
Name of Instructor
Session Topic
Description of Information To Be Presented In Session
Training Material To Be Used
(list all reference documents, films, etc., to be used)
Time Allotted for Session
Name of Instructor
Session Topic
Description of Information To Be Presented In Session
Training Material To Be Used
(list all reference documents, films, etc., to be used)
Time Allotted for Session
Name of Instructor
Session Topic
Description of Information To Be Presented In Session
Training Material To Be Used
(list all reference documents, films, etc., to be used)
Time Allotted for Session
Name of Instructor
Page of 3