State of New Mexico Environment Department

Environmental Health Bureau

Liquid Waste Program

Septage Pumper Application Form

!115
Name of Company
Mailing Address

3005 N Canton Aye, Farrnington, NM 87401

eo

Phone Number
EmailAddress

a
4
cjse

tJzov
Have you completed the NAWT Vacuum Truck Technician Training Certification Program or a
comparable program?

You must demonstrate familiarity with the applicable regulations and demonstrate competence in locating and
exposing septic tanks, measuring septic sludge and scum levels, the complete pumping of septic tank sludge,
NO
maintenance of pumping equipment in a sanitary condition and prevention of pathogen transmission and
preparation of an appropriate safety plan for normal operations
NMED considers completion of the National Association of Wastewater Technicians (NAWT) Vacuum Truck
Technician_Training_Certification_Program_demonstrating_competence_for_these_requil-emnents.
Do you understand tha tyou must maintain your equipment to ensure no sewage spill occurs during
ES
NO
transport or storage and that your employees or the public are not subject to a hazard to public health?
Do you have a written contingency plan for spill abatement and shall have the equipment and supplies
(y NO
needed_to_abate_spills_onsite_during_each_pumping_operation?
Do you understand that there must be a Certified Septage Pumper on-site any time that a septic tank is
NO
pumped?
List all the facilities that you use for the septage disposal. Upon request you may be asked to provide copies of any permits or
licenses issued by the owner of the disposal facility to the septage pumper
Septage Disposal Facilities that I use:
i.
rc
ie >
isi
e.vc c. 4

By signing below, I akcnowledge that I have read the Liquid Waste Disposal and Treatment Regulations and I understand the
sections of the regulations that pertain working as a septage pumper.

(7(et.
Septage Pumper Name Printed

Septage pumper Signature

Date

Please Complete this Application and attach your NA WT Vacuum Truck Technician Training certificatioiz and Send to
Michael Broussard, EHB Liquid Waste Specialist, 2450 Cain mo Edward Ortiz, Santa Fe, NM 87505; Fax 505-827-1839
For more information please contact Michael Broussard at Michael.Broussard@state.nm.us or 505-476-0125
Once you are approved by NMED your name will be added to the Septage Pumper list on the Liquid Waste Programs website

o
fr
LW-904D (Revised 2-4-15)

Vo

I)irectoi: of bducation

Dee

NEHA Approved Credit Hours: 6.0

& W.1.!I.

VC.a.4

NAWT

NAWT
Vacuum ruck Technician Training Certification Program

March 10, 2013

has completed the course

Glenn Lanham

This is to certify that

CERTIFICATE of COMPLETION

Ixit
Qnbironment epartmnt
2540 QEamino Qbbarb QrtI

fIll 87507
ffax (505) 827-1839
.nmenb.tate.nm.uZ
auta ffe,

uSana fflarti,ie
abernor

jone (505) 827-1840

iTITCIJC
3loljii
lieutenant obernor
.

Qtabinet

ecretarp

ittcD Vlonite
eutitv %ccrctarv

EertIficatc Qi( 3?eitration

Certificate No. D15 13338

Ianjam, .Mcnn
Is hereby registered as a Septage Pumper in accordance with NMAC
20.7.3.904D.
The registered individual above is required to meet the following requirements:
Septage pumpers shall demonstrate familiarity with applicable regulations and demonstrate competence
in locating and exposing septic tanks, measuring septic sludge and scum levels, the complete pumping of
septic tank sludge, maintenance of pumping equipment in a sanitary condition, prevention of pathogen
transmission and preparation of an appropriate safety plan for normal operations.
o Septage pumpers shall maintain his or her equipment to ensure no sewage spills occur during
transport or storage and that his or her employees or the public are not subjected to a hazard to public
health.
o Septage pumpers shall have a written contingency plan for spill abatement and shall have the
equipment and supplies needed to abate spills onsite during each pumping operation.
o Septage pumpers shall notify the department of the facilities they use for the septage disposal and shall
provide the department with copies of any permits or licenses issued by the owner of the disposal facility to
the septage pumper.
o 20.7.3.306 STANDARDS; SEPTAGE: Disposal of septage shall occur only at a permitted facility with
the knowledge and consent of the facility owner, and shall not cause a hazard to public health nor degrade a
body of water. Transport and disposal of septage shall be in conformance with applicable federal, state and
local regulations. Septage pumpers shall keep customer invoices and disposal records for three years and
shall, upon written request by the department, make such records available to the department for
inspection.

Registered this day 18 May 2015

+lic(jact rottir1
jjF11Q iiiiroitintnti1 )ca1tIj 1trciu1
LIgtiili Waste peti1It