NJDEP | Open Public Records Act | Online OPRA Record Request Form

Requester Information:

To increase the Department’s ability to correspond and respond to your record request, please complete as much applicable information as possible.

First Name*:

Middle Initial:

Last Name*:

Affiliation/Company*:

Street Address*:

Street Address (Alt or Additional):

Residency:

NJ RESIDENTS

City*:

NON-NJ RESIDENTS

City*:

State* (or country if not U.S.)

Zip Code*:

Daytime Phone Number*:

- - Ext:
check if number is unlisted

Fax Number:

- -

E-mail Address:
(Important)

Requested Records Information

Submit one request per Facility/Site interest. A Facility/Site Interest relates to a distinct facility and/or property. If the Facility/Site interest comprises a contiguous property, with multiple street addresses or Blocks & Lots, then specify below.

Do Not submit multiple requests for different Facility/Site Name AKAs (i.e., Also Known As) for the same address. Simply include the AKAs in the Request Details field.

Do Not submit one request for different Facility/Site interests, including non-contiguous properties. To ensure proper investigation and integrity of the results, separate OPRA requests are required.

Name of the facility, name of the operator, and name of the owner of the facility or parcel of land:

Facility Name:
Operator Name:
Owner Name:

Street address, block and lot of the parcel of land:

(Note: if the single Facility/Site interest in question is over multiple blocks and lots, please list all in the request details field below)

Street Address 1:
Street Address 2:

Block & Lot information is important to certain NJDEP Program Areas such as Land Use Regulation.

Block:
Lot:

County and Municipality where the facility, site or parcel of land is located:

Municipality - County:

Describe the parcel of land where the facility, site, or concern is located:

Property Description:

If the request is in reference to a particular permit issued by NJDEP, please provide the type of permit and any identifying numbers such as permit, incident or case numbers.

Type of Permit:
ID Numbers:

Or look up OPRA data for a particular site by Program and ID on-line:

Search by Program and ID

Request Details:

Please describe the records sought in a way that will permit the Department to identify and locate them.

If you are conducting an environmental due diligence investigation (e.g. Environmental Phase I, performing a Preliminary Assessment) and seek access to all identifiable remedial, permitting, compliance, and enforcement records for the subject property, select the type of due diligence.

Type of Diligence:

Otherwise, describe the records sought below. To expedite your request, please be as specific as possible*:

Please select how you want to access your record request information:

Access Method:

Submittal Certification:

Have you been convicted of any indictable offense under the laws of New Jersey or any other state of the United States? (response under penalty of N.J.S.A. 2C:28-3)*

Yes
No

Ceritfy this form by entering your initials in the field on the right:*

Initials:

Privacy Disclaimer: An OPRA request for access to a government record is itself public information. Therefore, the person requesting access to the government record should be aware that the information provided on the form may be disclosed.