REFERENCE DOCUMENTS - RAL25/0004 (As Published)

Form

Contaminated land investigation document

 

 

PART C—DECLARATIONS BY THE SUITABLY QUALIFIED PERSON AND THE RELEVANT PERSON

 

Section 566 of the EP Act requires
the suitably qualified person(s) to
make this declaration.

NEPM Schedule B9 and DES
Guideline - Assessing a Suitably
Qualified Person should be referred
to when determining whether a
person is suitably qualified to

perform these regulatory functions.

The SQP responsible for the CLID
must complete Appendix 1 before

signing the declaration.

Any additional SQP(s) who
conducted technical professional
services in support of the
responsible SQP must complete the
separate Professional Support Team
— Suitably qualified person
declaration form and submit it as

part of the CLID submission.

DECLARATION BY THE SUITABLY QUALIFIED PERSON

I, , declare that with
regard to the submitted contaminated land investigation document:

e | have the qualifications and experience relevant to preparing the
submitted contaminated land investigation document. | have provided
evidence of my qualifications and experience in Appendix 1 of this form.

e | have not knowingly included false, misleading or incomplete
information in the document.

e | have not knowingly failed to reveal any relevant information or
document to the administering authority.

e The document addresses the relevant matters for the contaminated land
investigation and is factually correct.

e The opinions expressed in the document are honestly and reasonably
held.

 

Signature: Date:

 

 

 

 

Section 390(2) of the EP Act
requires the relevant person to make

this declaration.

The relevant person must complete
Appendix 2 before submitting this

DECLARATION BY THE RELEVANT PERSON
l, , declare that:

e | have not knowingly given any false or misleading information to the
auditor who certified the document; and
e | have given all relevant information to the auditor; and

 

 

 

 

 

 

 

 

 

form.
| am the land’s owner, or
As | am not the land’s owner, | have given a copy of the
contaminated land investigation document to the land’s owner
e [understand that all information supplied on or with this form may be
disclosed publicly in accordance with the Right to Information Act 2009
and the Evidence Act 1977.
Signature: Date:
End of Part C

 

 

 

Page 12 of 24 * ESR/2023/6339 + Version 1.03 + Last reviewed: 19 MAY 2023 Department of Environment and Science

Document Set ID: 23717062
Version: 0, Version Date: 01/01/1900