Appeal Form - Environmental Appeals Board

POPA

The information requested is necessary to allow the Environmental Appeals Board to perform its function. The information is collected under the authority of the Protection of Privacy Act, SA 2024, c P-28.5, sections 4(c), 5(1)(p), and 5(2) for the purposes of administering the Environmental Appeals Board’s appeals program. The collection of personal information is authorized pursuant to section 5 of the Environmental Appeal Board Regulation. Questions about the Environmental Appeals Board’s collection of information should be directed to: Gilbert Van Nes, General Counsel, Environmental Appeals Board, 306, Peace Hills Trust Tower, 10011 – 109 Street, Edmonton, AB T5J 3S8 or e-mail at gilbert.vannes@gov.ab.ca. The information you provide will be considered a public record.

Title

TO THE ENVIRONMENTAL APPEALS BOARD, TAKE NOTICE THAT, I

First Name *

Surname *

Address *

Town/City *

Postal Code *

Phone *

Fax

Email *

Statement

consider myself affected by a decision made according to the Environmental Protection and Enhancement Act, the Water Act, the Emissions Management and Climate Resilience Act or the Government Organization Act, and hereby appeal to the Environmental Appeals Board.

The information collected on this form is necessary to allow the Environmental Appeals Board to perform its function. The information is collected under the authority of the Freedom of Information and Protection of Privacy Act, section 33(c). Section 33(c) provides that personal information may only be collected if that information relates directly to and is necessary for the processing of your appeal. The information you provide will be considered a public record. If you have concerns with your information being part of the public record or if you have questions about how the Board deals with your information, please contact Gilbert Van Nes, General Counsel, Environmental Appeals Board.

If you are being represented, please supply the following information regarding the person representing you:

First Name

Surname

Address

Town/City

Postal Code

Phone

Fax

Rep Email

Info

You must provide all the information requested. If you have any questions, please contact the Board. The Board is separate and apart from Alberta Environment and Protected Areas and therefore the Board has no information related to any matters until a Notice of Appeal is filed and the Board requests the information from Alberta Environment and Protected Areas. We do not have your Statement of Concern that you filed with Alberta Environment and Protected Areas and if you want the Board to consider the matters raised in your Statement of Concern, you should repeat those concerns in this Notice of Appeal.

1. I am appealing the decision of (name and title of person from Alberta Environment and Protected Areas who made the decision) issued to (name of company or person): *

Date issued *

Location of operation or activity which is the subject of Alberta Environment and Protected Areas' decision (municipality, county, etc.): *

On what date and how did you receive notice of Alberta Environment and Protected Areas' decision: *

More

Please provide any further information you may have regarding the decision you are appealing. The information can be found on the decision or the notice of decision from Alberta Environment and Protected Areas and will assist us in processing your appeal:

Water Act (file, application, licence, approval, enforcement action, or other numbers)

Environmental Protection and Enhancement Act (file, application, approval, licence, enforcement action, reclamation certificate, or other numbers)

Emissions Management and Climate Resilience Act (file, compliance order, administrative penalty, or other numbers)

Government Organization Act (file, application, or other numbers)

Concerns

Please ensure that you state all your concerns, objections, and reasons in this Notice of Appeal as you may be prevented from raising them later in your appeal if you do not include them here. Please be specific and forward any additional information or documents if necessary to the Board to Gilbert Van Nes at gilbert.vannes@gov.ab.ca.

3. What parts of Alberta Environment and Protected Areas' decision do you not like? Please refer to the section of the approval, licence, reclamation certificate, order, etc., issued by Alberta Environment and Protected Areas.

4. (a) What are your concerns with Alberta Environment and Protected Areas' decision?

(b) How is Alberta Environment and Protected Areas' decision affecting you?

(c) Why do you not like the decision made by Alberta Environment and Protected Areas?

5. What would you like the Board to do to resolve the specific concerns you have noted above?

Please feel free to attach copies of any additional documents that may be of assistance to the Board.

Submitted by *

Dated at *

On *

Requirements

You are also required to provide the Board with an original, signed copy of your appeal that you are filing on line. Please print this form when you have completed and forward to:

Environmental Appeals Board
306 Peace Hills Trust Tower
10011 - 109 Street
Edmonton, Alberta
T5J 3S8

Or fax to 780-427-4693 or email to eab@gov.ab.ca

Signature:

Notice of Appeal Form

Notice of Appeal