31 FORM 3

AIR POLLUTION CONTROL (SPECIFIED PROCESSES) REGULATIONS 1987

APPLICATION FOR VARIATION OF A LICENCE PURSUANT TO SECTION 18, OR VARIATION OR CANCELLATION OF ANY TERM OR CONDITION OF AN EXEMPTION

PURSUANT TO SECTION 23, OF THE AIR POLLUTION CONTROI, ORDINANCE

[reg. 47

To: The Authority

1.

I/We* the undersigned, being the licence/exemption* holder of the undermentioned licence/exemption*, hereby apply under Section 18/23* of the Air Pollution Control Ordinance for the variation of a licenoe/variation or cancellation of a term or condition of an exemption for the conduct of the undermentioned specified process and I/we* hereby declare the following particulars and the additional information, if any, provided are correct and the relevant plans and specifications are prepared by the qualified engineer(s)/authorized person(s) listed in paragraph 3 of this application.

I/We* enclose the application fee of $100.

This application, including plans and specifications, comprises

pages.

2.

Dated this

Signature of Applicant

Name

Details of Owner(s)+

day of

19

Name of Owner(s)

Telephone

English

(Surname First)

Chinese

Status

Correspondence Address

Number

* Delete if not applicable

+ Inoluding the applicant

Identity Card/ Certificate of Incorporation*

Number

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