FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

This presentation will assist you in the completion of the Form 1014CA. The compliance agreement / one-time land application.

Date of Last Revision: 2010

Rule Requirement: 10-7-19(h)2, 10-7-26(h)2

Explanation of Form: Any person responsible for supervision of land application must submit a compliance agreement to the Commission. [Reference 165:10-7-19 and 165:10-7-26]

Question concerning this Form: For more information contact Pollution Abatement at (405) 522-5799.

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

NAME OF PERSON OR COMPANY DOING WORK IN THE FIELD

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

TYPE OF ENTITY DOING THE WORK IN THE FIELD

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

NAME OF THE OPERATOR

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

CHECK BOX FOR THE RULE THAT APPLIES

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

TELEPHONE NUMBER

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

DAY, MONTH AND YEAR WITH SIGNATURE BLOCK

FORM 1014CA – COMPLIANCE AGREEMENT / ONE-TIME LAND APPLICATION

NOTARY SIGNATURE BLOCK