A p p l i c a t i o n f o r A c t i v i t y R e g i s t r a t i o n - S M E
Address: Environment and Resources Authority Environmental Permitting Unit Hexagon House, Spencer Hill, Marsa. MRS 1441. Malta. Telephone: 2292 3500 E-mail: [email protected] Form GBR 14.3 Please complete in block letters. The requested information must be completed in full. Failure to provide adequate information will delay processing of the application. Date application was received and stamp: Reference Number: (For office use only). (For office use only)
N N N N N Y Y GBR n
Proposed Activity Location of Proposed Activity
Property
Street
Locality
Personal details of applicant or contact Details of company or institution on behalf of which person: the application is being made: SurnameRegistered CompanyName Name
Address: Address: RegisteredRegistered Address Address
Town: Town:
Postal Code: Postal Code:
Telephone Number: Telephone Number: Fax: Fax: Mobile: Mobile: E-mail: E-mail: ID card number: Company registration VAT Number: number: VAT Number: (VAT number to be included where available).
Application for Activity Registration- SMEs Page 1 of 4 1. Additional information
1.1 List all relevant development (planning) permits and any pending development applications on site quoting permit/application number. Provide a copy of the permit application which allows the proposed uses on site as Attachment 1. Sites where activities predate the Development Planning Act (2001) should attach an equivalent permit (e.g. PAPB permit) for the activity on site. Development permit/application number:
1.2 Attachment 2: Show the location of the site on a site plan of appropriate scale. Site plans may be downloaded from the Geoportal on the PA website (www.pa.org.mt) or can be purchased through the PA Mapping Shop.
1.3 Attachment 3: Provide a site layout plan showing the location and nature of major site features and activities and infrastructure being shared by two or more units, which are however manged by the site operator. Label the plan utilising the location codes in Table 1. The site layout plans should: - Include an A4 or A3 sized plan; - Be of a scale of 1:10,000 or 1:2,500 as appropriate; - Indicate the location of all processses described in section 2.1 below - Indicate in red the outline of the proposed site including all necessary infrastructure (existing and/or proposed), such as site access roads. All plans submitted must be dated and signed by the applicant.
1.4 Attachment 4: Provide a site drainage and effluent plan showing effluent discharge points on site including domestic sewage discharged to sewer, trade effluent and stormwater. Connections to such infrastructure from the seperate units is also to be shown. Label the drainage and effluent plan utilising the location codes in Table 1.
1.5 Attachment 5: Ptovide a copy of site management contract which will ensure that individual unit operators will apply for an environmental permit/ register their operations with the Authority.
2. Site Activities and Management
2.1 Describe the the main activities carried out on the site.
2.2 Contact details of company representative responsible for environmental issues.
Name:
Mobile:
E-mail:
Application for Activity Registration- SMEs Page 2 of 4 Table 1. – Site infrastructure Location Tick if Site feature Quantity Code applicable Codes for Attachment 3 as per section 1 MS Connection to main sewer CP Cess Pit ST Settlement Tank IP Oil water seperator/interceptor RV Clean water reservoir DR Foul water reservoir (untreated trade effluent) Codes for Attachment 4 as per section 1
ES Electricity sub station Boiler1 BL GR Generator1
FS Fuel storage
CS Chemical Storage
WA Waste storage area
WB Water Supply Booster
SP Sewage Pumping Station
If applicable, additional site features shall be described in the table below . F1
F2
F3
Titles of supplementary forms and documentation to be submitted Tick when provided Attachment 1: Copy of planning permit Attachment 2: Site plan Attachment 3: Site layout plan indicating: (a) Activities which are carried out in various areas; (b) All waste management infrastructure (c) Sources and emission points to atmosphere Attachment 4: Site drainage and effluent plan Attachment 5: Copy of site management contract Insert further documents as applicable
NB: The Authority may request any additional information it deems necessary to further process the application.
Applicant’s declaration
1 Provide additional information on air emission points and treatment.
Application for Activity Registration- SMEs Page 3 of 4 I apply for the environmental registration as indicated above, and declare that, to the best of my knowledge, all the information contained in this application and on the submitted supplementary forms and documentation is complete and correct. I also understand that any incomplete, fraudulent or misleading information will annul the application or permit, and may also incur any relevant penalties. I also declare that I have read the data protection clause below:
______Signed on behalf of/in my own name (in block letters) date
PLEASE READ THE FOLLOWING BEFORE SIGNING - Data Protection Clause In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), we will process any personal and/ or sensitive data supplied on/ in this application, request or notification form or subsequently supplied by yourself, whether orally or in writing, for all or any of the following:
1. The proper processing of your application, request and/or notice as submitted; 2. verification of the information provided to our officers; 3. Preventing, detecting and/or prosecuting fraud and any other criminal activity which the Authority is bound to report and/or act upon whilst meeting any other specific legal or regulatory obligations; 4. Establishing, exercising or defending any legal action; 5. Internal management, research and statistics, systems administration, the development and improvement of our services; 6. the protection and promotion of our legitimate interests and the proper conduct of our obligations arising under any law or statutory instrument; and 7. to make public the necessary information as specified in the relevant law and/or instrument.
Relevant data will be disclosed or shared as appropriate with all our employees and with other third parties if pertinent to any of the purposes listed above. Every field on the form is mandatory. Should you fail to fill in any mandatory field, we reserve the right to refuse the application. Should any field be inapplicable to your particular circumstances please mark that field with the letters “N/A”. You have the right to require that we provide you with access to your personal data as well as the right to rectify, or, in appropriate circumstances, erase/edit any inaccurate, incomplete or immaterial personal data which is being processed. However, you are required to inform us immediately of any alterations relating to your personal data which we are processing. By signing this form, you confirm that you are giving your explicit consent, in terms of the Data Protection Act, on behalf of yourself and all the other persons specified in this form for the Authority to process your respective personal information as outlined above and you confirm that you have brought this Data Protection notice to the attention of these other persons and obtained their respective consents. We undertake to implement appropriate measures and safeguards for the purpose of protecting the confidentiality, integrity and availability of all data processed.
Application for Activity Registration- SMEs Page 4 of 4