ENVIRONMENTAL CITATION

State of Arkansas

Ticket Number ___

Court Appearance:

You are directed to appear on the ___ of __, 20__, in

District Court of __ County, located at ____

___ at ___ a.m./p.m.

I PROMISE TO APPEAR IN SAID COURT AT SAID TIME AND PLACE.

I UNDERSTAND THE ABOVE AND THAT MY SIGNATURE IS NOT AN ADMISSION OF GUILT.

THE UNDERSIGNED issuing officer, duly authorized to issue environmental violation citations, on the ___ day of __ 20__, has identified evidence or has reason to believe the violation(s) set forth below were committed by or were found to be on the property of:

NAME: ________

DL#/ DOB ____________

ADDRESS: _____________

_____

PHONE: _________

SITE LOCATION: _______

The above listed person is accused of violating provisions of the following State environmental law(s):

{ } violation of the Used Tire Recycling and Accountability Act, A.C.A. § 8-9-401 et seq.

{ } violation of 8 CAR § 40-501 et seq.;

{ } violation of A.C.A. § 8-6-2005 (1), illegal dumping of solid waste or illegal disposal of solid waste on public or private property.

{ } violation of A.C.A. § 8-6-2005 (2), the creation or participation in the creation or furtherance of an illegal dump site;

{ } violation of A.C.A. § 8-6-2005 (3), the illegal disposal of solid waste or illegal dumping of solid waste has resulted from a property owner's own household activities on his or her own land that:

1. (A) Creates a public or private nuisance;
2. (B) Is a hazard to health; or
3. (C) Involves the open dumping of garbage

{ } other violation of Chapter 6 of Title 8 of the Arkansas Code.

Remediation must be completed by the _ day of _, 20____.

DEQ permitted facility disposal/processing receipts are required to be submitted to the issuing officer by the remediation completion date listed above.

Failure to appear in court as directed is grounds for issuance of an Arrest Warrant.

SIGNATURE: ________

The undersigned further states that he/she has just and reasonable grounds to believe that the accused committed the offense as stated herein either by causing or permitting the indicated violation contrary to law on said property within ____ County.

ISSUING OFFICER: _____ License #_____

For further information regarding this notice, contact _______

____ at ____