Industrial Soil and GW2 Zone

CONVEYANCE NOTIFICATION Industrial Soil and GW2 Zone

(Name of current property owner) hereby notifies the public that the following described Area of Investigation (AOI), Louisiana Department of Environmental Quality (LDEQ) Agency Interest Number (list AI number), was closed with contaminant levels present that are acceptable for industrial/commercial use of the property and groundwater meeting the definition of a Groundwater 2 Zone as described in LDEQ’s Risk Evaluation/Corrective Action Program (RECAP), Sections 2.9 and 2.10. In accordance with LAC 33:I., Chapter 13, if land/aquifer use changes from industrial to non-industrial or from Groundwater Classification 2 to Groundwater Classification 1, the responsible party shall notify the LDEQ within 30 days and the AOI shall be reevaluated to determine if conditions are appropriate for the proposed land/aquifer use. In accordance with RECAP Sections 2.10 and 2.17, a domestic or agricultural supply well shall not be installed within the boundary of the groundwater plume on the property.

This site was closed in accordance with the Louisiana Administrative Code, Title 33:I., Chapter 13. Additional information on the environmental conditions of this property is available in the Louisiana Department of Environmental Quality’s Electronic Document Management System (EDMS) filed under Agency Interest Number (AI) (list AI number). The EDMS is available online at www.deq.louisiana.gov/EDMS or by visiting one of the Public Records Centers. For information or assistance, contact the Customer Service Center at (225) 219-LDEQ (5337) or toll free (866) 896-LDEQ.

A completed RECAP Conveyance Notice Form is attached.

______Signature of Property Owner or Their Authorized Representative1

Typed Name and Title of Property Owner or Their Authorized Representative

(A true copy of the document certified by the parish clerk of court must be sent to the Underground Storage Tank Division, Post Office Box 4313, Baton Rouge, Louisiana 70821- 4313.)

1By signing this document, the person signing is certifying that he/she has actual authority to sign this conveyance notice and the actual authority to carry out the obligations contained in the notice, if any. Signing without actual authority may constitute the filing of false public documents under La.R.S. 14:133.

USTform_1001_r05 05/02/2016