REFERENCE DOCUMENTS - RAL25/0004 (As Published)

                                                                                                                                     Notice
                                                                                     Duty to notify of environmental harm

                                               TIME                                                              DATE

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            8. Details of registered owners or occupiers of affected land to which notice has been
               given
                 Note: Registered owners or occupiers of affected land do not need to be notified before notifying the
                 administering authority.
            8.1. Have any registered owners or occupiers of affected land been notified of this incident?

                  I am the sole owner/occupier of the land ☒ Yes              ☐ No
                  *If no, please provide details of the occupiers and registered owners of land affected, or potentially
                  affected, by this incident including details of how notice to those persons was given.



              NAME                                                                       TELEPHONE

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              POSTAL ADDRESS

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              DESCRIPTION OF HOW NOTICE WAS GIVEN

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                     If you require additional space you may attach the information on a separate sheet.

            9. Declaration
                 Note: If you have not told the truth in this application you may be liable for prosecution under the relevant
                 Acts or Regulations.
                 I do solemnly and sincerely declare that the information provided is true and correct to the best of my
                 knowledge. I understand that it is an offence under s. 480 of the Environmental Protection Act 1994 to give
                 to the administering authority or an authorised person a document containing information that I know is
                 false, misleading or incomplete in a material particular.

                 I understand that all information supplied on or with this notification form may be disclosed publicly in
                 accordance with the Right to Information Act 2009 and the Evidence Act 1977.

              NOTIFYING PERSON’S SIGNATURE                                          DATE
                                              ACTING CEO NOOSA COUNCIL
                                                                                    30/05/2023


            10. Phoning the pollution hotline
                  In addition to providing the written notice if you become aware of a matter which has caused or threatens
                  serious or material environmental harm you should immediately call the pollution hotline on 1300 130 372




            Page 8 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