Dep 065 Form – Fill Out and Use This PDF

The DEP-065 form, issued by the New Jersey Department of Environmental Protection, serves as an official Licensed Operator in Charge Employment Notification for wastewater facilities. It is designed to notify the department about the commencement or termination of employment of individuals licensed to operate wastewater facilities within the state. Individuals are required to provide comprehensive information, including personal contact details, license numbers, the facility's information, and a commitment to the operational requirements.

For those looking to update their employment status or ensure compliance with New Jersey's environmental protection standards, filling out the DEP-065 form accurately is crucial. Click the button below to begin the process of filling out your form.

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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.

Question	Answer
Form Name	Dep 065 Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	nj licensed wastewater, nj form wastewater, licensed operator form wastewater, nj dep employment notification

How to Edit Dep 065 Form Online for Free

The DEP 065 form is straightforward to open and complete using FormsPal's free online PDF editor. Licensed wastewater operators in New Jersey use this form to file employment change notifications with the NJDEP. Whether you are taking on a new licensed operator role or ending your current assignment, the DEP 065 form is the required filing to keep your facility's compliance records current with the New Jersey Department of Environmental Protection. Follow the steps below to complete your form:

Step 1: Open the DEP 065 Form

Click the "Get Form Button" at the top of this webpage to open the DEP 065 form in FormsPal's online PDF editor. The editor loads the full document in your browser, no software download required. You can begin filling in fields immediately after the form opens.

Step 2: Review the Document and Gather Required Information

Before you start entering data, review the complete form to understand what each section requires. You will need your NJDEP license number, your license classification, the name and permit number of the wastewater treatment facility, and the date your employment begins or ends. Having this information ready before you start ensures accuracy and saves time.

Our editor supports all standard form operations: filling in text fields, adding a digital signature, editing existing text, inserting images, and more. You can save your progress at any point and return to complete the form later.

Tips for Completing the DEP 065 Form Accurately

This form requires precise, official information. Review these important tips before you begin filling in each section:

Tip 1: Use your name and details exactly as they appear on your NJDEP operator license. Discrepancies between the form and your license record can delay NJDEP processing and may require resubmission.

Tip 2: Confirm the facility's full legal name and exact permit number. The NJDEP cross-references this information against active facility records, so any mismatch can put the facility's compliance status at risk.

Tip 3: Double-check the employment date. The date you enter determines when NJDEP considers the notification effective. Use the actual start or end date of employment, not the date you are completing the form.

Completing the Form Fields

1. Start with Section I. While completing the DEP 065 form, begin with the fields shown here:

licensed operator form wastewater writing process clarified (step 1)

2. Once Section I is complete, add the required information in SECTION III Your request to, the week and month of the employment change, SECTION IV STATEMENT FROM the facility, and the FOR OFFICE USE ONLY area so you are able to progress further.

FOR OFFICE USE ONLY, SECTION IV STATEMENT FROM, and week month of licensed operator form wastewater

Errors in the FOR OFFICE USE ONLY section are common. Review each entry carefully before you finalize the form.

Step 3: Review and Download

Before you finalize, go through every section one more time to confirm all fields are complete and accurate. When you are confident the form is ready, click "Done" to lock in your entries. You can then download the completed DEP 065 form as a PDF or print it directly from FormsPal. Every change you make is saved automatically, so the form remains available in your account if you need to revisit it later.

FormsPal is committed to protecting user privacy. All information you enter in our editor is kept secure and is not shared with third parties. For other New Jersey licensing and compliance forms, explore our New Jersey forms collection or browse all available employment notification forms on FormsPal.