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Nhdes Form Site
Processed
promptly, please include the $150 fee (if applicable).
2. Site Name
3. Site Location
Information
To provide subsequent notification and/or update biennial reporting data (to update site
identification information). Reason:
Company Name:
Street Address:
City or Town:
State:
County Name:
Zip Code:
4. Site Land Type
5. NAICS Code(s)
(available at
www.naics.com)
A.
B.
C.
D.
6. Site Contact
Person
First and Last Name:
Title:
Phone Number and Extension:
Email address:
7....
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