MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY
REMEDIATION DIVISION
PO BOX 30426, LANSING, MI 48909-7926
Phone 517-373-9837, Fax 517-373-2637
E-mail DEQ-STD-TANKS@michigan.gov

FREE PRODUCT WEB TRANSMITTAL
Authorized by the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, (Act 451), Part 213
INSTRUCTIONS: Complete this form to notify the Remediation Division (RD) within 24 hours of the discovery of free product as required under Act 451. Failure to provide this notification may result in fines as provided in Act 451.
Fields marked with a (!) are required. You will not be able to submit the form without completing them.
SEND TO:
(!) Select a MDEQ RD District Office. (Click here for a list of DEQ RD District Offices.)
Select by office: 
Select by county:
SENT BY:
(!)Person Reporting the Discovery:
CAPTCHA (!) Anti-Spam Code: Write the characters in the image:
(!)Company:
(!)Address:
(!)Telephone Number:
Fax Number:
(!)email Address:
SITE INFORMATION:
(!)Facility Name:
(!)Contact Person:
(!)Phone Number:
Address of Facility:
County:
(!)Facility ID# (required for all facilities):
(!)Date/Time Free Product was discovered:
(!)Identification of Free Product:
(!)Location of Product:
(!)Thickness of Product:
(!)Action Taken:
(!)Type of Product Recovery:
(!)Quantity (gallons) of Free Product Recovered:
Comments

 

EQP 3800 (02/2003)