Lisburn Online Forms - Dry Cleaning PPC Application

Dry Cleaning PPC Application

Application for Permit - Dry Cleaning

Local Authority Pollution Prevention and Control (LAPPC)

Pollution Prevention and Control Regulations (NI) 2003

Essential notes on completing application form

This application form has a fee of £139.00

A1.1 Name of the Installation
Name:
A1.2 Please give the address of the installation
Street name and number:
Town:
Postcode:
Country:
Telephone Number:	+
Ordnance Survey National Grid Reference (eg.SJ 123 456):
Please provide the information requested below about the "operator", which means the person who it is proposed will have control over the installation in accordance with the permit (if granted)
A1.3 Existing permits
Please give details of any existing Permits for the installation, including reference number(s):
A2.1 The Operator
Please provide the full name of the company or corporate body or the name of the sole trader or the names of the partners:
Trading/Business name (if different):
Registered Office Address (incl postcode):
Principal Office Address (if different) (incl postcode):
Company Registration Number:
A2.2 Holding Companies
Is the operator a subsidiary of a holding company within the meaning of Section 736 of the Companies Act 1985? (please tick the appropriate box):
Name of Ulimate holding company:
Ultimate holding company Registered Office Address (incl postcode):
Principal Office Address (if different) (incl postcode):
Company Registration Number:
B1 About the Installation
Please provide the following information about your installation, having regard to the attached notes and ensuring you reference your reponse to each point
B1.1 Attach a plan of the premises:
See B1.1 notes
Doc Reference:
B1.2 Attach a description of the location and methods of storage of dry cleaning solvents/residue:
See B1.2 notes
Document Reference:
B1.3 List make, model, name/number, serial number, load capacity, date of installation and type of dry cleaning solvent used in the table 1 below:
Table 1:
B1.4 - Provide details of checking and maintenance procedures:
See B1.4 Notes
Document Reference:
B1.5 - Provide details of any other activities using organic solvents:
See B1.5 notes
Document Reference:
B1.6 - Provide details of training and qualifications:
See B1.6 notes
Document Reference:
B1.7 - Provide details of methods to weigh and record product:
See B1.7 notes
Document Reference:
B1.8 - Provide details of methods used to determine solvent use:
See B1.8 notes
Document Reference:
B1.9 Risk Phrase Solvents
Confirm use of any of the following risk phrase materials:
See B1.9 notes
R45 : R46 : R49 : R60 : R61:	NoYes
If Yes, provide full details of how and why these risk phrase materials are used and how the requirements of the amendment 1C of Schedule 1 of the Solvent Emissions (NI) Regulations 2004, S1 107, substitution, control and limiting of emissions of risk phrase materials will be met.
C1 Fees and Charges
See C1 notes
C1.1 Please state the amount enclosed as an application fee for this installation.
Fee: £ (We will confirm receipt of this fee when we write to you acknowledging your application:
C1.2 Please give any company purchase number or other reference you wish to be used in relation to this fee.
Purchase Order Number:
C2 Annual Charges
See C2 notes
C2.1 Please provide details of the address you wish invoices to be sent to and details of someone who we may contact about fees and charges within your finance section (incl postcode and telephone number):
C3 Commercial Confidentiality
C3.1 Is there any information in the application that you wish to justify being kept from the public register on the grounds of commerical confidentiality?:	No Yes
If Yes, please provide full justification considering the definition of commercial confidentiality within the PPC Regulations - Document Reference:
C4 Data Protection
See C4 notes
C5 Declaration
C5.1 Name of current applicant(s)*
I/We certify that the information in this application is correct. I/we apply for a permit in respect of the particulars described in this application (including supporting documentation) I/We have supplied. Please note that each individual applicant must sign the declaration themselves even if an agent is acting on their behalf. For the application form:
Premises Name:
Name:
Position:
Date:
Name:
Position:
Date:
* Where more than one person is defined as the applicant, all should sign. Where a company or other body corporate - an authorised person should sign and provide evidence of authority from the board of the company or body corporate.

For further information please contact ehealth@lisburn.gov.uk +44 (0)28 9250 9394

Data Protection Act 1998

Lisburn City Council collects the data on this form for the purposes of the management and application of the Pollution Prevention and Control Regulations (NI) 2003. This data may be passed to other relevant Government agencies.