Attachment A: TFL Applicant Compliance Information Form
Attachment A: TFL Applicant Compliance Information Form (for renewal application only) (revised (10/19/2023)) Please check Yes or No to the following questions. If you answer yes to any of the questions below, you must complete the Table of Enforcement Actions on the next page. A. During the three years immediately preceding submission of this application, has the applicant been convicted in any jurisdiction of a criminal violation of any environmental law? Yes______ No______ B. During the three years immediately preceding submission of this application, has a civil penalty been imposed upon the applicant in any local, or federal judicial proceeding for any violation of an environmental law? Yes______ No______ C. During the three years immediately preceding submission of this application, has a civil penalty exceeding five thousand dollars been imposed on the applicant in any local, or federal administrative proceeding for any violation of an environmental law? Yes______ No______ D. …
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Attachment A: TFL Applicant Compliance Information Form (for renewal application only) (revised (10/19/2023)) Please check Yes or No to the following questions. If you answer yes to any of the questions below, you must complete the Table of Enforcement Actions on the next page. A. During the three years immediately preceding submission of this application, has the applicant been convicted in any jurisdiction of a criminal violation of any environmental law? Yes______ No______ B. During the three years immediately preceding submission of this application, has a civil penalty been imposed upon the applicant in any local, or federal judicial proceeding for any violation of an environmental law? Yes______ No______ C. During the three years immediately preceding submission of this application, has a civil penalty exceeding five thousand dollars been imposed on the applicant in any local, or federal administrative proceeding for any violation of an environmental law? Yes______ No______ D. During the three years immediately preceding submission of this application, has any state, including local, or federal court issued any order or entered any judgment to the applicant concerning a violation of any environmental law? Yes______ No______ E. During the three years immediately preceding submission of this application, has any local, or federal administrative agency issued any order to the applicant concerning a violation of any environmental law? Yes______ No______ Applicant (Business) Name: ______________________________________ (As indicated on the TFL Application Form) Completed by: _________________________________________________________________ (Print Name and Signature) Title: _____________________________________ Date: ___________________ GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS --------0-------- DEPARTMENT OF PLANNING AND NATURAL RESOURCES ENVIRONMENTAL PROTECTION DIVISION 4611 Tutu Park Mall 45 Mars Hill, Frederiksted Suite 300, 2nd Floor St. Croix, VI 00840 St. Thomas, VI 00802 (340) 773-1082 (340) 774-3320 dpnr.vi.gov Table of Enforcement Action (attach additional sheets if needed) Type of Enforcement Action Date Jurisdiction Case Number Description of Violation For more information concerning TFL application requirements, please contact the DPNR, Division of Environmental Protection at (340) 773-1082 (STX) or (340) 774-3320 (STT), or visit the DPNR website at http://dpnr.vi.gov. DISCLAIMER: Information contained in this Fact Sheet is current as of October 12, 2023. Statutory or regulatory changes that may occur after that date may cause part or all the information to become invalid. If there are any questions concerning the status of this information, please contact the TFL Program Manager at (340) 773-1082.