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

NOTICE OF ON-SITE WORK ACTIVITY 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) 48 hours in advance of on-site activities as required under Act 451. Failure to provide this notification may result in fines as provided in Act 451. Click here for a complete list of DEQ RD Offices and their phone/fax numbers.
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. (See the list of DEQ RD District Offices.)
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SENT BY:
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(!)Company/Division:
(!)Street Address:
Street Address (cont.):
(!)City:
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(!)Zip:
(!)Area Code & Telephone Number:
(!)Fax Number:
(!)email Address:
SITE INFORMATION:
(!)Facility Name:
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Street Address (cont.):
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(required for all facilities):
MERA Site ID#:
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NOTE - TELEPHONE THE DISTRICT OFFICE ASAP IF SCHEDULE CHANGES.
(!)Starting Time:
(!)Ending Time:

 
(!)Type of Activity:
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COMMENTS:

EQP 3801 (02/2003)