This government document is issued by Department of Environmental Protection for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:gul-_xwuyho&q=https://files.dep.state.pa.us/PublicParticipation/Public%2520Participation%2520Center/PubPartCenterPortalFiles/Environmental%2520Quality%2520Board/2021/March%252016/7-533%252091-92a%2520Fees/05b_7-533%252091-92a%2520Fees_Final_Forms.pdf&sa=U&ved=2ahUKEwjVmKf0qdX8AhVgTqQEHZzUC284KBAWegQICRAB&usg=AOvVaw0KiXqsZ5St3pnfApvKmUBx