The applicant for an ADS license shall complete and submit the “Asbestos Disposal Site Contractor License”, form NHDES-A-01-015 dated January 1, 2026, available at https://onlineforms.nh.gov/?FormTag=NHDES-A-01-015 or via the department’s website at www.des.nh.gov, the following information:

1. (a) The applicant’s name, mailing address, physical address, e-mail address, telephone type, and telephone number;
2. (b) If applicable, a list of alternate names, acronyms, or other identifiers by which the applicant is, or has been, known by or uses, or has used to conduct business or perform work;
3. (c) Whether the application is initial or a renewal;
4. (d) Whether the applicant is an individual, corporation, partnership, firm, association, sole proprietorship, political subdivision, or other kind of association or organization;
5. (e) If the applicant is an individual, the applicant’s date of birth;

6. (f) If the applicant is an employer or contractor, then for each of its responsible persons not listed pursuant to (h) below, having primary responsibility for, and control over, the asbestos abatement work of the applicant, the individual’s:

   1. (1) Name;
   2. (2) Title; and
   3. (3) Mailing address;
7. (g) The name, title, mailing address, email address, telephone type, and telephone number of the individual affiliated with and designated by the applicant to be contacted regarding the application;

8. (h) For each responsible person who fulfills the licensing requirement specified in Env-A 1817.10(b), the following additional information or documentation about each such individual:

   1. (1) Name;
   2. (2) Title and principal duties;
   3. (3) Telephone number; and
   4. (4) Current New Hampshire asbestos disposal site worker certification number;

9. (i) Whether any state or federal agency has taken any of the following with regard to environmental, health, or safety requirements against the applicant within the previous 10 years:

   1. (1) Enforcement action; or
   2. (2) Action related to license, certification, or application for a license or certification, such as suspension, revocation, or denial, against the applicant or its responsible persons;

10. (j) If applicable, a copy of each of the following state or federal action(s) against the applicant within the last 10 years unless previously submitted, including its responsible persons, with regard to environmental, health, or safety activities, and the current status of each such action:

    1. (1) Enforcement action;
    2. (2) Action related to a license or certification, such as suspension or revocation; or
    3. (3) Action related to an application for a license or certification, such as denial;
11. (k) A copy of the list, specified in Env-A 1817.10(f), of all individuals currently employed or otherwise associated with the applicant who, under the authority of the applicant's license, if issued, will perform work relating to the disturbance of asbestos at an ADS;
12. (l) If the applicant is not an individual, a certificate of good standing from the New Hampshire secretary of state;
13. (m) Whether the applicant has been issued an asbestos-related license or certification for asbestos abatement work within the previous five years by any other state or federal agency;
14. (n) If applicable, a copy of each asbestos-related license or certification issued, unless previously submitted; and
15. (o) Date and sign the application as specified in Env-A 1817.04.

Source. (See Revision Note #1, Revision Note #2, and Revision Note #3 at chapter heading for Env-A 1800) #14104, eff 11-1-24; ss by #14467, eff 1-1-26, EXPIRES: 1-1-36