Program Interest Number for Site:
Activity Number:
Name of Site as known to NJDEP:
Street Address of Site:
Municipality of Site:
County of Site:
Submission Type Acronym:
Submission Description:
Name of LSRP (or consultant) overseeing work:
LSRP’s License Number: 
LSRP’s Email Address:
Name of GIS Author Company:
Mailing Address:
Name of Professional performing GIS work:
Email for Professional performing GIS work:
Phone Number for Professional performing GIS work: