(Trade E3luent Notice) Section 119 Water Industry Act (1991) GL322010 WBSM-1L6111-1000 Application for a Temporary Trade E3luent Discharge Consent
*please refer to guidance notes
Section A: Reason for application A1. Reason for applying for a temporary discharge consent: A2. Date you are proposing to start discharging? / / ...... X X X X 2 0 1 4 A3. What is the proposed end date? ...... X X / X X / 2 0 1 4 ...... A4. Have you had a temporary discharge licence from Southern ...... Water before? Yes No
*Section B: Company details (Legal entity responsible for consent) Must not be consultant or agent acting on behalf of discharger
B1. Company trading name: ...... B4. Contact name: ......
B2. Address: ...... B5. Landline number: ......
...... B6. Mobile: ......
B3. Postcode: ...... B7. Email: ......
Section C: Site details (Premises from where the temporary discharge will be made)
*C1. Nature of business conducted on site? *Contact for invoicing purposes: ...... C10. Address (if different from site): ...... C11. Postcode (if different from site): ...... *C2. Trading name: ...... C12. Contact name: ...... *C3. Address: ...... C13. Job title: ...... C14. Landline number: ...... *C4. Postcode: ...... C15. Mobile: ...... *Contact for Trade E3luent purposes:
C16. Email: ...... C5. Contact name: ......
C6. Job title: ......
C7. Landline number: ......
C8. Mobile: ......
C9. Email: ......
Continues on next sheet 1 Section D: Trade E3luent Discharge details
*D1. What process(es) does the trade eDluent come from? ...... (e.g. site commissioning work, tank testing, groundwater discharge, pipework flushing/disinfection) ...... Please enclose Material Safety Data Sheet (MSDS) for any chemicals used in the process: ...... *D3. Does the trade eDluent have any pre-treatment prior to ...... discharge? Yes No
...... If so, what? Please enclose a plan showing the position of the ...... pre-treatment plant on site: ......
...... D4. How many days per week will you discharge trade eDluent? *D2. What chemicals or other contamination will the discharge contain (please attach sample analytical information if available)? ...... D5. What hours of the day will you discharge trade eDluent?
...... : am to : pm *D6. What is the maximum volume that you will discharge in a ...... working day (24 hours)? ...... (cubic metres)
...... D7. What is the proposed maximum flow rate? (litres per second) ......
Section E: Water supply details E2. If you have a mains supply, who is your supplier?
E1. How is your water supplied? Southern Water Mains South East Water Private borehole Wessex Water Abstraction Thames Water Other e.g rainwater harvesting Sembcorp Bournemouth Water
...... Portsmouth Water
...... Sutton & East Surrey Water ADinity Water ...... Other – please specify ______...... *E3. Please provide the account reference number for the site:
......
2 Section F: Site drainage details F1. Location of discharge point (i.e. road name). Please provide F2. Is the discharge connection to a foul or surface water sewer? drainage plan Foul ...... Surface water
...... Combined Unknown ......
Section G: Checklist and declaration Please ensure that you have included the following items with this I confirm to the best of my knowledge that the information I have application: supplied is accurate and representative of the trade eDluent I am proposing to discharge. Drainage Plan
Signature: ...... Sample analytical data (if applicable) Name: ...... Pre-treatment location plan (if applicable) Job title: ...... MSDS for chemicals used on site (if applicable) Date: ...... Please complete this form in full and provide relevant information, as any incomplete submissions will delay the Please email this form and any relevent information to: processing of your application. [email protected] or send by post to: Completion of this form does not grant you permission to Trade E3luent, Southern House, Falmer, Brighton, BN1 9PY discharge Trade E3luent. 4 1 . 7 3 0 Notes to assist with the completion of the application form for a Temporary Trade E3luent Consent
Section B: Company details
B1 – B7 These are the details of the Company making the trade eDluent discharge and who will have legal responsibility for the discharge, both consent stipulations and bill payment
Section C: Site details
C1 This requires a description of your Company’s main business activities (not the process producing the trade eDluent)
C2 – C4 This is the location of the premises from which the discharge will be made
C5 – C9 Contact for trade eDluent purposes i.e. who will be responsible for the quality and quantity of trade eDluent discharged
C10 – C16 Contact for invoicing purposes i.e. who will be responsible for financial matters and authorising payments. Invoices will be sent to this address
Section D: Trade e3luent discharge details
D1 This requires a specific description of the site operation that produces the eDluent that is to be discharged to the sewer. This should be as detailed as possible as this will be used on the legal Consent document. You are required to provide copies of all Material Safety Data Sheets for all chemicals used in the process
D2 Please describe in detail the composition of the trade eDluent. A certificate of analysis from a suitably accredited laboratory must accompany the description to indicate the typical constituents of the trade eDluent. If the process has not commenced you are obliged to locate a similar process in order that the composition may be determined
D3 Please describe the processes in as much detail as possible (i.e. fat trap, oil interceptor, biological treatment plant). A plan or drawing must be provided showing the position of the plant on site and detail of the process itself
D6 Please remember to include all contributing flows, such as washdown, concentrates and rinse waters
Section E: Water supply details
E3 The site’s account number(s) can be found on your water supply bills