Demand that a EIS be done!!


Fill in the affidavit with your personal concerns and [insert your county] 

Instructions for filling out

Environmental Impact Statement (EIS)

Demand Form & Affidavit

                                   Read Carefully


Before you print out the EIS Demand Form & Affidavit which are printed on one piece of paper, please read the 2 instructions below:


1.) Use the blank EIS form and type in the state and county you are located in. 

2.) List your reason(s) for demanding an EIS be done on the North Dakota Pipeline (NDPL).



Go ahead and print out the document. The top half of the document is the EIS Demand Form. The bottom half of the document is the Affidavit.


Let’s begin with the EIS Demand Form at the top of the document. There are 3 things you need to pay attention to when filling it out:



1.) Print legibly so that your writing can easily be read.


2.) Write both your City and State after your street address on the second line.


3.) Remember only ENVIRONMENTAL reasons can be listed for demanding an EIS.


Such as the threat to your drinking water being contaminated. Your quality of life lowered, rivers polluted, wildlife and wetlands destruction



You only have to list a couple of good reasons that pertain to you or your household and your quality of life from an environmental standpoint. For instance, does anyone in your household have asthma or respiratory problems? Do you have a shallow well? Any elderly living in the home?



Now let’s go to the Affidavit at the bottom half of the document. There is only 1 thing you need to pay attention to when filling out it out (in the presence of a notary public, of course):



1.) Sign on the line under the word “AFFIDAVIT” and then write your legal name the way you sign checks, etc. on the “AFFIANT” line when you’re present at your notary’s office.  Your bank or insurance company will most likely notarize your affidavit for you at no cost. By law, notaries in the state of Illinois and Iowa can only charge $1.00.


That’s all there is to it. CONGRATULATIONS! You did it! THANK YOU FOR YOUR HELP!


 There is a group of concerned citizens that have taken on an environmental issue to protect Iowa and our nations waters called Blue Waters. 

 (Iowa Citizens Against the Bakken Pipeline) who have been working diligently since last year to educate themselves, the public, and local officials of all negative impacts that this petroleum pipeline would have on the environment, rivers, wildlife, and communities overall. 

If you have any questions, please call  309-721-1800 or 319-361-2348


  Please return the affidavits soon as possible to the address below.

The permit stage is fast approaching!


Quad Cities Waterkeeper INC.

Arthur W. Norris                                                        

736 Federal St. Suite # 2426                      

Davenport, IA 52803                                       

[email protected]                                 


Thank you so much for making a difference.


This gives the public a speaking voice.

Download your EIS sheet below.

Don't forget to add your state and county

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