1. (a) The following individuals seeking initial certification to disturb asbestos at an ADS shall apply as specified in (b) below:

   1. (1) An experienced ADS worker or worker-in-training applying for the first time;
   2. (2) Individuals seeking re-certification to disturb asbestos at an ADS more than 3 years after their most recent certification has expired; and
   3. (3) Individuals seeking re-certification to disturb asbestos at an ADS after their most recent certification has been revoked.
2. (b) The individual seeking initial certification shall complete and submit to the department by mail, hand delivery, or electronic means an “Asbestos Disposal Site Worker/Worker-in-Training Certification”, form NHDES-A-01-012 dated January 1, 2026, available at https://onlineforms.nh.gov/?FormTag=NHDES-A-01-012 or via the department’s website at www.des.nh.gov.

3. (c) The applicant shall include the following on the form specified in (b) above:

   1. (1) The applicant’s name, mailing address, telephone number, telephone type, email address, and date of birth;
   2. (2) The name, address, email address, telephone type, and telephone number of each entity or individual licensed, or to be licensed pursuant to Env-A 1817, with whom the applicant is currently employed or otherwise associated for the performance of work involving the disturbance of asbestos at asbestos disposal sites;
   3. (3) Whether any state or federal agency is taking or has taken any enforcement action or action related to a license, certification, or application for a license or certification, such as suspension, revocation, or denial, against the applicant or its responsible persons with regard to environmental, health, or safety requirements within the previous 10 years;
   4. (4) If applicable, a copy of each state or federal enforcement action or other action against the applicant, unless previously submitted, and the current status of each such action;
   5. (5) Whether the applicant is seeking certification as an experienced worker or a worker-in-training, based on the criteria provided in Env-A 1818.09(b);
   6. (6) One clear, color photograph, taken within the last 5 years, of the applicant’s full face, meeting passport photograph requirements including the name of the applicant;

   7. (7) Written documentation showing that the applicant meets the certification requirements specified in Env-A 1818.09, including:

      1. a. For an initial application, a copy of the record required by Env-A 1819.04(c);
      2. b. A statement by the applicant attesting that the applicant has met the requirements of Env-A 1818.09(a); and
      3. c. For an application for an initial experienced worker, a work experience record, signed by the work supervisor(s), documenting a minimum of 40 hours that the applicant has engaged successfully in the disturbance of asbestos at an ADS pursuant to the requirements in Env-A 1818.09(c);
   8. (8) 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 perform work;
   9. (9) Whether the applicant has been issued an asbestos-related license or certification for asbestos abatement work within the previous 5 years by any other state or federal agency;
   10. (10) If applicable, a copy of each asbestos-related license or certification issued, unless previously submitted; and
   11. (11) Whether the application is initial or a renewal.

4. (d) The applicant shall date and sign the application certifying that:

   1. (1) The applicant has read, and understands, the New Hampshire asbestos management and control rules, Env-A 1800;
   2. (2) The application has been prepared in conformity with Env-A 1800; and
   3. (3) All information contained in the application, including any supplements attached, is true, complete, and not misleading to the best of the knowledge and belief of the signer.

5. (e) The applicant shall submit a non-refundable application fee with each application as follows:

   1. (1) For applications submitted in calendar year 2026, $75; and
   2. (2) For applications submitted in calendar year 2027 and subsequent years, $100.
6. (f) The applicant may specify on the form that the company mailing address be used rather than the applicant’s mailing address, for all application related correspondence from the department.

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