ALUDPA Appeal Request (post ALUDPA penalty decision)

This form is to be used when an appeal to an ALUDPA Enforcement Authority PENALTY DECISION is being requested.
DO NOT COMPLETE if you have not received a determination letter from the ALUDPA stating the complaint has been reviewed and a penalty assessed. Use the RESPONSE form if responding to initial complaint filing notice.

Date Date / MM / DD YYYY
ALUDPA Violation/Case Number (ex:25-400)
Maximum of 7 characters allowed. Currently Entered: 0 characters.
Entity Name Noted on Violation Case
Mailing Address
Contact Name Contact Name First Last
Contact Email
Contact Phone Contact Phone - ### - ### ####
Noted Violation on ALUDPA Determination Notice
Explanation for why violation finding is being appealed. (Be thorough with details, explanation and documentation)
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Acknowledgement

Acknowledgement I understand I am submitting an appeal to the ALUDPA violation determination I received. This information will be submitted to the Alabama Underground Damage Prevention Authority (ALUDPA) for a hearing. I understand I am not expected to appear before the ALUDPA. The appeal information I have submitted will be reviewed by the ALUDPA. The ALUDPA has the option to uphold the original ALUDPA Executive Committee finding, make an alternate finding or dismiss the violation. I will be informed after the hearing of the ALUDPA determination. Any further appeal must be filed in circuit court no more than thirty (30) days from the date of the final order.
Name Name First Last
Date Date / MM / DD YYYY
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