Dep 065 Form – Fill Out and Use This PDF

Dep 065 Form PDF Details

The DEP-065 form is New Jersey's official employment notification for licensed wastewater treatment facility operators. The New Jersey Department of Environmental Protection (NJDEP) requires all licensed operators to file this form whenever they begin or end their role at a regulated wastewater facility. Timely submission ensures that NJDEP records correctly identify who is the licensed operator in charge at each facility at all times, which is essential for regulatory compliance and environmental protection. The form covers four sections that must each be completed accurately. Section I – Applicant Contact Information: Enter your full legal name, current mailing address, telephone number, NJDEP license number, and license classification. This information goes directly into the NJDEP operator registry and must match the details on your current license. Section II – Employment Notification: Enter the date your employment begins or ends at the facility, the full legal name of the wastewater treatment facility, and its NJDEP permit number. Specify clearly whether this notification is for a new employment start or a termination. This is the core section of the DEP 065 form and determines how NJDEP updates the facility compliance record. Section III – Operator Request: This is the licensed operator's written request to the facility, confirming qualifications and a commitment to meet all NJDEP operational requirements for wastewater treatment. Section IV – Facility Statement: This section requires an authorized representative of the employing facility to sign and acknowledge acceptance of the operator's role. Both signatures are required before submission. Operators who fail to file the DEP 065 form promptly after an employment change may disrupt the facility's continuous compliance status. NJDEP may take enforcement action against facilities that operate without a properly recorded licensed operator in charge. The DEP-065 is a single-page form submitted to the NJDEP Bureau of Licensing, Pesticide Operations, and Operator Certification. Wastewater treatment facilities across New Jersey — from municipal treatment plants to industrial discharge facilities — must maintain accurate operator employment records through this filing requirement. Keeping your DEP 065 form current is one of the most important steps a licensed operator can take to maintain compliance and protect a facility's operating permit. For related New Jersey regulatory forms, see the A-5088-TC NJ Form and our collection of employment notification forms.