Attachment A: TFL Applicant Compliance Information Form  
(for renewal application only) 
(revised (10/19/2023)) 
 
Please check Yes or No to the following questions.  If you answer yes to any of the questions below, you 
must complete the Table of Enforcement Actions on the next page.  
 
A.  
During the three years immediately preceding submission of this application, has the 
applicant been convicted in any jurisdiction of a criminal violation of any environmental 
law? 
Yes______  
 
 
No______ 
 
B.  
During the three years immediately preceding submission of this application, has a civil 
penalty been imposed upon the applicant in any local, or federal judicial proceeding for any violation 
of an environmental law?  
 
Yes______  
 
 
No______ 
 
C.  
During the three years immediately preceding submission of this application, has a civil 
penalty exceeding five thousand dollars been imposed on the applicant in any local, or 
federal administrative proceeding for any violation of an environmental law?  
 
Yes______  
 
 
No______ 
 
D.  
During the three years immediately preceding submission of this application, has any state, 
including local, or federal court issued any order or entered any judgment to the applicant 
concerning a violation of any environmental law?  
 
Yes______  
 
 
No______ 
 
E.  
During the three years immediately preceding submission of this application, has any local, or 
federal administrative agency issued any order to the applicant concerning a violation of any 
environmental law?  
 
Yes______  
 
 
No______ 
 
Applicant (Business) Name: ______________________________________ 
(As indicated on the TFL Application Form) 
 
Completed by:  _________________________________________________________________  
(Print Name and Signature) 
 
Title: _____________________________________ 
 
Date: ___________________ 
 
 
 
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
--------0-------- 
DEPARTMENT OF PLANNING AND NATURAL RESOURCES 
ENVIRONMENTAL PROTECTION DIVISION 
            4611 Tutu Park Mall  
 
              45 Mars Hill, Frederiksted 
            Suite 300, 2nd Floor 
                                       St. Croix, VI 00840 
            St. Thomas, VI  00802                                                       (340) 773-1082 
            (340) 774-3320   
 
                                                    dpnr.vi.gov 
 
Table of Enforcement Action 
(attach additional sheets if needed)
Type of 
Enforcement Action 
Date 
Jurisdiction 
Case 
Number 
Description 
of Violation 
For more information concerning TFL application requirements, please contact the DPNR, Division of 
Environmental Protection at (340) 773-1082 (STX) or (340) 774-3320 (STT), or visit the DPNR website at 
http://dpnr.vi.gov. 
DISCLAIMER: Information contained in this Fact Sheet is current as of October 12, 2023.  Statutory or regulatory 
changes that may occur after that date may cause part or all the information to become invalid. If there are any 
questions concerning the status of this information, please contact the TFL Program Manager at (340) 773-1082. 
--------
--------
--------
--------