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Community Right To Know Fee Exemption Request Form

*Company Name:
*FEIN (Federal Employer Identification Number):
*Mailing Address: Street Address, City, Zip City State: Zip
*Physical Address: Street Address, City, Zip City State: Zip
*Contact Name:

*Phone Number :  
*Email Address:

*Reason for Fee Exemption (Check All That Apply):

Administrative Office Only No Facility in New Jersey Non User of Environmental Hazardous Substances

Incorrect NAICS Code Must Indicate Correct Six Digit Code

See http://www.census.gov/eos/www/naics/

Exempt NAICS Subcategory Code Company Out of Business

Other Explain:

* Required Fields

   
 

 

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Copyright © State of New Jersey, 1996-2003
Department of Environmental Protection
P. O. Box 402
Trenton, NJ 08625-0402

Last Updated: April 16, 2013