Deq Form 7106 R01 – Fill Out and Use This PDF

CERTIFICATION

I, the undersigned certify, under provisions in Louisiana and United States law which provide criminal penalties for false statements, that to the best of my knowledge and belief formed after reasonable inquiry, the information submitted, including all attachments thereto are true, accurate and complete.

New Permit Liability Holder/Company Name
New Billing Address
City		State				Zip
Signature of New Responsible Official				Date
Printed/Typed Name and Title
Previous Permit Liability Holder/Company Name
Previous Billing Address
City		State				Zip
Signature of Previous Responsible Official				Date
Printed/Typed Name and Title

NOTE: If information and signatures are not obtainable from the previous owner, then the new owner must apply

for a new permit. The previous owner has the option to request termination of the existing permit.

NOTE: Instructions and requirements for NOC-1 Form are located on Page 5.

NOTE: Please see new fee amounts on Page 5.

form_7106_r06	NOC-1 Form
06/30/17	Page 4 of 5

INSTRUCTIONS AND REQUIREMENTS FOR NOC-1 FORM

FOR COMPANY NAME CHANGES, FACILITY NAME CHANGES, PERMIT TRANSFERS, OWNERSHIP CHANGES,

AND/OR OPERATOR CHANGES (FOR ALL MEDIA)

The NOC-1 form is to be submitted when a permit is transferred, a company’s name changes, a facility’s operator changes, or a facility’s name changes in accordance with LAC 33:I. Chapter 19. Submission of this form shall in no way constitute approval of the change request. The office will notify the requestor in writing of the decision regarding the change request. All

information must be provided. Do not leave any sections blank. Use N/A if not applicable.

1.Prior to or no later than 45 days after a change has occurred, submit one completed and signed original NOC-1 Form and one copy for each facility (Agency Interest No.). List all permits under the agency interest number for all media. Note the different sections for permit transfers and/or company name changes or facility name changes. The “effective date of transfer” is the specific date of transfer of the permit responsibility, coverage, and liability between the previous and new permittee.

2.Submit Proof of Registration with the LA Secretary of State. If your company is a corporation or a limited liability company, attach a copy of your company’s Certificate of Registration and/or Certificate of Good Standing from the Louisiana Secretary of State. All documents must use the company name as it is specified with the Louisiana Secretary of State. To ensure that the proper name is on your form, please check the LA Secretary of State’s Corporation Database at: https://coraweb.sos.la.gov/CommercialSearch/CommercialSearch.aspx.

3.Submit payment. All payments made by check, draft, or money order shall be payable to LA Department of Environmental Quality. For electronic funds transfer (EFT), contact the LDEQ Office of Management and Finance. For online payments, see http://business.deq.louisiana.gov/. Submit fees as follows:

	Air Permits	company name change, transfer,		per permit	$	500
		ownership or operator change
	Hazardous	company or facility name change, transfer,		per permit	none
		ownership or operator change
	Waste
	Permits	Note: This form does not substitute for the HW-1 form.
		company or facility name change		per permit	none
		transfer, ownership or operator change:
	Solid
		•	Type I, IA, II, IIA	per permit	$ 1,650
	Waste
	Permits
		• Type III, Beneficial Use		per permit	$	413
		•	Waste Tire Processors	per permit	$	125
		company or facility name change		per permit	none
		transfer, ownership or operator change:
	Water	•	general permit (LAG)	per permit	none
	Permits	•	individual	per permit	10% of the calculated annual fee but not less
					than $ 380, excluding oyster fee
		•	LAJ Biosolids	per permit	none
		Note: Stormwater permits beginning with LAR04, LAR05 and LAR10 are not transferrable.

If you would like assistance with Notification of Changes, please contact the Permit Application Administrative Review Group at 225-219-3292.

Completed package should be sent to:

	Permits Application Administrative Review Group
	Public Participation and Permit Support Division
	Office of Environmental Services
	LA Department of Environmental Quality
	Post Office Box 4313
	Baton Rouge, LA 70821-4313
form_7106_r06	NOC-1 Form
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