REFERENCE DOCUMENTS - RAL25/0004 (As Published)

                                                                                                                                 Notice
                                                                                     Duty to notify of environmental harm

                  Describe what the change in condition involves

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                  If additional space is required attach the information on a separate sheet and make reference to that sheet here.

            7.3. Cause of change in condition (if known)?
                  Describe the known factors that have led to the change in condition

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                  If additional space is required attach the information on a separate sheet and make reference to that sheet here.

            7.4. Timeframe of change in condition
                  Outline what is known of the timeframe in which the change in condition has occurred

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            7.5. Type of environment affected:
                  What is the type of environment that has been affected by the matter or change in condition?

                    ☐Waterway/drain                   ☐Marine                    ☐Estuarine             ☐Freshwater
                    ☐Land contamination               ☐Urban area                ☐Air/fallout           ☐Vegetation
                    ☐Protected area                   ☐Other         Click or tap here to enter text.


            7.6 How did you become aware of the change of condition

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            7.7. What was the source of information about change in condition

                   ☐ own observation
                   ☐ information provided by a person with relevant competencies
                   ☐ information provided by an employee

            7.8. When did you first became aware of the change in condition for which notice is given




            Page 7 of 9 • ESR/2016/2230 • Version 4.00 • Last Reviewed : 12 April 2023              Department of Environment and Science
Document Set ID: 23717062
Version: 0, Version Date: 01/01/1900