ࡱ>  3bbjbjVV .<<Z8K44Hh(&>&& R*($&((+++(+(++'{EW4*}H׀0H~|+(||$'Z['@+'4''''+'''H((((|''''''''' :  A2 Application form Application for a permit Local Authority - Integrated Pollution Prevention and Control Pollution Prevention and Control Act, 1999 Environmental Permitting (England and Wales) Regulations 2007 Introduction When to use this form This environmental permitting regime is known and referred to as Local Authority Integrated Pollution Prevention and Control (LA-IPPC). Installations permitted under this regime are known as A2 installations. Use this form if you are sending an application for a Part A2 installation to a Local Authority under the Environmental Permitting (England and Wales) Regulations 2007 (the EP Regulations), SI 2007/3538. Before you start to fill in this form You are strongly advised to read relevant parts of the Defra general guidance manual issued for LA-IPPC and LAPPC, republished in 2008 and available at  HYPERLINK "http://www.defra.gov.uk/environment/ppc/localauth/pubs/guidance/manuals.htm" http://www.defra.gov.uk/environment/ppc/localauth/pubs/guidance/manuals.htm. This contains a list of other documents you may need to refer to when you are preparing your application, and explains some of the technical terms used. You will also need to read the relevant sector guidance note, BREF note or Process Guidance note. The EP Regulations can be obtained from The Office of Public Sector Information, or viewed on their website at  HYPERLINK "http://www.opsi.gov.uk/legislation/about_legislation.htm" http://www.opsi.gov.uk/legislation/about_legislation.htm. Which parts of the form to fill in You should fill in as much of this form as possible. The appropriate fee must be enclosed with the application to enable it to be processed further. When complete return to: Environmental Protection Team, Regulatory Services, Level 3, Town Hall, Westoe Road, South Shields, Tyne & Wear, NE33 2RL, Contact Tel No: 0191 4247904 Other documents you may need to submit There are number of other documents you will need to send us with your application. Each time a request for a document is made in the application form you will need to record a document reference number for the document or documents that you are submitting in the space provided on the form for this purpose. Please also mark the document(s) clearly with this reference number and the application reference number, if you have been given one, it will be at the top of the form overleaf. If you do not have either of these, please use the name of the installation. Using continuation sheets In the case of the questions on the application form itself, please use a continuation sheet if you need extra space; but please indicate clearly on the form that you have done so by stating a document reference number for that continuation sheet. Please also mark the continuation sheet itself clearly with the information referred to above. Copies - not relevant for e-applications Please send the original and [ ] copies of the form and all other supporting material, to assist the Authority in conducting any necessary consultation process. If you need help and advice We have made the application form as straightforward as possible, but please get in touch with us at the local authority address given above if you need any advice on how to set out the information we need. LA-IPPC application form: to be completed by the operator For Local Authority use Application reference  Officer reference Date received  A1 Applicant details A1.1 Name of the installation A1.2 Please give the address of the site of the installation Postcode _________________ Telephone ______________________ If known, the Ordnance Survey national grid reference 8 characters, for example, SJ 123 456 (can be obtained from typing postcode into one of the on-line mapping sites)  A1.3 Existing permits: Please give details of any existing LAPPC or LA-IPPC authorisation for the installation, or any waste management licences or water discharge consents, including reference number(s) and type(s): 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). A2.1 The operator please provide the full name of company, partnership, or corporate body Trading/business name (if different) Registered Office address Postcode: Principal Office address (if different) Postcode: Company registration number A2.2 Holding companies Is the operator a subsidiary of a holding company within the meaning of section 1159 of the Companies Act 2006? No Yes if yes, state name of ultimate holding company Registered office address Postcode Principal Office address (if different) Postcode Company registration number: A3.1 Who can we contact about your application? It will help is to have someone who we can contact directly with any questions about your application. The person you name should have the authority to act on behalf of the operator (this can be an agent or consultant). Name Position Address Postcode telephone number fax number email address B1 About the installation Please fill in the table below with details of all the current activities in operation at the whole installation. In Column 1, Box A, please identify all activities listed in Schedule 1 to the EP Regulations that are, or are proposed, to be carried out in the stationary technical unit of the installation. In Column 1, Box B please identify any directly associated activities that are, or are proposed, to be carried out on the same site which: * have a technical connection with the activities in the stationary technical unit * could have an effect on pollution In Column 2, for Boxes A and B, please quote the Chapter number, Section number, A(2) or B, then paragraph and sub-paragraph number as shown in Part 2 of Schedule 1 to the EP Regulations. [For example, Manufacturing glass and glass fibre, unless falling within Part A(1) of that Section, where melting capacity of the plant is more than 20 tonnes per day, would be listed as Chapter 3, Section 3.3, Part A(2)(a).] B1.1 Installation table for new permit application COLUMN 1 COLUMN 2 Box A Activities in the stationary technical unit Section in Schedule 1 to the EP Regulations       Box B Directly-associated activities Schedule 1 references (if any)             B1.2 Why is the application being made?  The installation is new  The installation is existing, but changes to the installation or to the EP Regulations means that an LA-IPPC A2 permit is required. B.1.3 Site maps Please provide:- A suitable map showing the location of the installation clearly defining extent of the installations in red Doc Reference A suitable plan showing the layout of activities on the site, including bulk storage of materials, waste storage areas and any external emission points to atmosphere Doc Reference A suitable plan showing the site drainage system and all discharge points to drainage or water courses. Doc Reference B2 The installation Please provide in this section written information about the aspects of your installation listed below. We need this information to determine whether you will operate the installation in a way in which all the environmental requirements of the EP Regulations are met. B2.1 Describe the proposed installation and activities and identify the foreseeable emissions to air, water and land from each stage of the process (this will include any foreseeable emissions during start up, shut down and any breakdown/abnormal operation) The use of process flow diagrams may help to simplify the operations Doc Reference: B2.2 Once all foreseeable emissions have been identified in the proposed installation activities, each emission should be characterised (including odour) and quantified. atmospheric emissions should be categorised under the following (i) point source (eg chimney/vent, identified by a number and detailed on a plan) (ii) fugitive source (eg from stockpiles/storage areas). If any monitoring has been undertaken please provide the details of emission concentrations and quantify in terms of mass emissions. If no monitoring has been undertaken please state this. (Emission concentration = eg milligrams per cubic metre of air; mass emission = eg grams per hour, tonnes per year) water emissions should be identified at discharge points and copies of any discharge consents from either the Environment Agency or sewerage undertaker should be submitted, detailing the permitted discharge limits. Doc Reference: B2.3 For each emission identified, describe the current and proposed technology and other techniques for preventing or, where that is not practicable, generally reducing the emissions and the impact on the environment as a whole. If no techniques are currently used and the emission goes directly to the environment without abatement or treatment this should be stated. Doc Reference: B2.4 Identify the raw and auxiliary materials, other substances and water that you propose to use in carrying on the activities listed in the table in B1.1. Doc Reference: B2.5 Characterise and quantify each waste stream from the installation and describe the proposed measures for waste prevention and reduction. Please also include waste management, issues storage and handling of the waste. [For each waste stream, identify if an environmental appraisal has been undertaken, and provide details; if not please state why an appraisal has not been undertaken. If you propose any disposal of waste, explain why recovery of that waste is technically and economically impracticable, and go on to describe the measures planned to minimise the production of that waste so as to avoid or reduce any impact on the environment.] Doc Reference: B2.6 Identify if there may be a discharge of any List I or List II substance and if any are identified, explain how the requirements of the Groundwater Regulations 1998 (SI 2746) have been addressed (see attached lists). Also describe the current techniques used to prevent and reduce discharges to groundwater. Doc Reference: B2.7 Provide a breakdown of the proposed energy consumption and generation by source and end-use, and describe the proposed measures for improvement of energy efficiency. If you have entered a climate change levy agreement please provide details. Doc Reference: B2.8 Describe the proposed systems to be used in the event of unintentional releases and their consequences. This must identify, assess and minimise the environmental risks and hazards, provide a risk based assessment of any likely unintentional releases, including the use of historical evidence. If no assessments have been carried out please explain Doc Reference: B2.9 Detail the following with respect to noise and vibration (i) the main sources of environmental noise and vibration as identified from your proposed installations activities (including infrequent sources); (ii) Identify the nearest noise sensitive locations and include any relevant environmental noise measurement surveys which have been undertaken; (iii) The current and proposed technology and techniques for the control of noise. If no assessment has been carried out, please explain. Doc Reference: B2.10 Describe the proposed measures for monitoring all identified emissions including any environmental monitoring, and the frequency, measurement methodology and evaluation procedure proposed (eg particulate matter emissions, noise measurements). Include the details of any monitoring which has been carried out which has not been requested in any other part of this application. If no monitoring is proposed for a particular emission from the installation please state the reason. Doc Reference: B2.11 Describe the proposed measures to be taken, to avoid any pollution risk to land and return the site of the installation to a satisfactory state upon definitive cessation of activities, you may wish to refer to the site report requested at B3.1 below. Doc Reference: B2.12 Provide detailed procedures and policies of your proposed environmental management techniques, in relation to the installation activities described. Doc Reference: B3 Site report B.3.1 Please provide a site report which demonstrates the condition of the land on the site of the installation. The report must identify any existing or potential sources of contamination, quantifying the presence of materials in, on or under the land which may constitute a pollution risk either in terms of toxic or polluting potential or the potential generation of toxic, flammable or asphyxiant gases. The report should consider, in relation to such sources the potential existence of pathways via which the contaminants travel, and the proximity and nature of potentially sensitive receptors. During consideration of the likely presence of materials and the design of any intrusive sampling strategies, particular regard should be given to the locations and extent of any former or existing potentially contaminative uses and the locations, nature and likely emissions to land of processes forming part of the installation. It is acceptable to provide site reports undertaken for other purposes, (eg planning applications, which have been carried out up to 6 months prior to submitting this application). Older site reports may, at the discretion of the local authority, be accepted where a further site survey and risk assessment based on the present condition of the site are submitted. Note: As a first step you should undertake a desk study to produce the information necessary for the report. If that study suggests that there are matters which warrant more detailed investigation, then site surveying work may be necessary. Doc Reference: B4 Impact on the environment Please provide written information about the impact the installations emissions may have on the environment as listed below. B4.1 Provide an assessment of the potential significant local environmental effects of the foreseeable emissions (eg is there a history of complaints, is the installation in an air quality management area?) Doc Reference: B4.2 Provide an assessment of whether the installation is likely to have a significant effect on sites of special scientific interest (SSSIs) or European protected sites and, if it is, provide an assessment of the implications of the installation for that site, for the purposes of the Conservation (Natural Habitats etc) Regulations 1994 (see appendix 2 of Annex XVIII of the General Guidance Manual). Doc Reference: B5 Environmental statements and the non-technical summary B5.1 Has an environmental impact assessment been carried out under The Town and Country Planning (Environmental Impact Assessment)(England & Wales) Regulations 1999/293, or for any other reason with respect to the installation? If there has been no such assessment, have there been any screening opinions or directions?  No  Yes please supply a copy of the environmental impact assessment and details of any decision made Doc Reference: B5.2 Please provide a non-technical summary of all the information required above. This will enable the public to understand your installation and its environmental impact when viewing the public register. Doc Reference: B6 National consultee We will use the information in this section to identify who we will consult about your proposals B6.1 In which Primary Care Trust (formerly health authority)/Health Board area is the installation located? If premises are on a boundary please give names of all relevant authorities B6.2 Could the installation involve the release of any substance into a sewer vested in a sewerage undertaker?  No  Yes please name the sewerage undertaker B6.3 Are there any sites of special scientific interest (SSSIs) or European protected sites which are within 2 kilometres of the installation?  No  Yes please give names of the sites B7 Planning Status B7.1 Where the installation may involve a specified waste management activity we cannot issue a permit unless one of the following applies, please indicate which of the following applies to the installation:  You have planning permission (please enclose copy of decision notice) Doc Reference  You have a certificate of lawful existing use of development (please enclose copy of certificate) Doc Reference  You have an established use certificate (please enclose copy of certificate) Doc Reference  The General Permitted Development Order applies Please give details (please enclose copy of relevant paperwork) Doc Reference  Planning permission is not required (please say why and enclose written confirmation from the planning authority) Doc Reference For further advice on the above planning issues, please contact the local planning authority. B8 Additional information Please supply any additional information which you would like us to take account of in considering this application. Doc Reference C1 Fees and Charges The enclosed charging scheme leaflet gives details of how to calculate the application fee. Your application cannot be processed unless the application fee is correct and enclosed. C1.1 Please state the amount enclosed as an application fee for this installation: For the local authority (cheques should be made payable to [ Council] For the Environment Agency (cheques should be made payable to [ ] We will confirm receipt of this fee when we write to you acknowledging your application. C1.2 Please give any company purchase order number or other reference you wish to be used in relation to this fee. C2 Annual subsistence charges If we grant you a permit, you will be required to pay an annual subsistence charge, failure to do so will result in revocation of your permit and you will not be able to operate your installation. C2.1 Please provide details of the address you wish invoices to be sent to and details of someone we may contact about fees and charges within your finance section. Postcode: Telephone: 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 commercial or industrial confidentiality? No Yes Please provide full justification, considering the definition of commercial confidentiality within the EP Regulations. Doc Reference C3.2 Is there any information in the application that you believe should be kept from the public register on the grounds of national security? No Yes Do not write anything about this information on the form. Please provide full details on separate sheets, plus provide a copy of the application form to the Secretary of State/ Welsh Ministers for a direction to exclude information on grounds of national security. C4 Data Protection The information you give will be used by the local authority to process your application. It will be placed on the relevant public register and used to monitor compliance with the permit conditions. We may also use and or disclose any of the information you give us in order to: consult with the public, public bodies and other organisations, carry out statistical analysis, research and development on environmental issues, provide public register information to enquirers, make sure you keep to the conditions of your permit and deal with any matters relating to your permit investigate possible breaches of environmental law and take any resulting action, prevent breaches of environmental law, offer you documents or services relating to environmental matters, respond to requests for information under the Freedom of Information Act 2000 and the Environmental Information Regulations 2004 (if the Data Protection Act allows) assess customer service satisfaction and improve our service. We may pass on the information to agents/ representatives who we ask to do any of these things on our behalf. It is an offence under regulation 38 of the EP Regulations, for the purpose of obtaining a permit (for yourself or anyone else), to: make a false statement which you know to be false or misleading in a material particular, recklessly make a statement which is false or misleading in a material particular intentionally to make a false entry in any record required to be kept under any environmental permit condition with intent to deceive, to forge or use a document issued or required for any purpose under any environmental permit condition. If you make a false statement we may prosecute you, and if you are convicted, you are liable to a fine or imprisonment (or both). C5 Declaration: previous offences (delete whichever is inapplicable) I/We certify EITHER No offences have been committed in the previous five years which are relevant to my/our competence to operate this installation in accordance with the EP Regulations. OR The following offences have been committed in the previous five years which may be relevant to my/our competence to operating this installation in accordance with the regulations: ________________________________________________ ________________________________________________ Signature Name Position Date C6 Declaration C6.1 Signature of current operator(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 operator must sign the declaration themselves, even if an agent is acting on their behalf. For the application from: Installation name: Signature Name Position Date Signature Name Position Date * Where more than one person is defined as the operator, all should sign. 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