MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY

PETITION FOR CONTESTED CASE HEARINGS
Permit or Application NO: (On permit or application as assigned by MDEQ)
The procedural authority for a contested case hearing is the Michigan Administrative Procedures

Act, 1969 PA 306, as amended; MCL 24.201 et seq.; MSA 3.560 (101) et seq.

Information requested on this form may be provided in an alternative, written format or additional pages may be attached.

PETITIONER’S NAME or AGENT’S NAME
MAILING ADDRESS (If different from street address)
STREET ADDRESS
CITY	STATE	ZIP CODE
CITY	STATE	ZIP CODE
TELEPHONE No.

( )
Statement of Authority:
I petition a contested case hearing be initiated under the authority of: NATURAL RESOURCES and ENVIRONMENTAL PROTECTION
ACT, 1994 PA 451, as amended. MCL 324.101 et seq.; MSA 13A.101 et seq., PART(s):
ADMINISTRATIVE RULE:

Statement of matters asserted, including the site location and other pertinent facts:
Petitioner’s relationship/interest to the activity or proposed project:
Relief sought by Petitioner:
SIGNATURE OF PETITIONER/AGENT	DATE
Submit this completed Petition and attachments to:

OFFICE OF ADMINISTRATIVE HEARINGS

MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY

PO BOX 30473

LANSING MI 48909-7973	NOTICE:

COPY OF DEPARTMENT’S FINAL ACTION ON AN APPLICATION OR PERMIT MUST BE ATTACHED TO THIS OR ANY ALTERNATIVE WRITTEN PETITION
EQP 0201 (03/96)

DEQ - PETITION FOR CONTESTED CASE HEARINGS (Print only)

DEQ - PETITION FOR CONTESTED CASE HEARINGS (Print only)

Rebecca Patrick

2001-01-17

WASZAKM

MDEQ