[reg. 4.]
FORM 3
AIR POLLUTION CONTROL (SPECIFIED PROCESSES) REGULATIONS
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 CONTROL ORDINANCE
1987 Ed.]
Air Pollution Control (Specified Processes) Regulations
[CAP. 311
F 23
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 licence/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.
To: The Authority
This application, including plans and specifications, comprises
pages.
Dated this
day of
19
Signature of Applicant
Name
Details of Owner(s)†
Name of the Owner(s)
(Surname First)
English
Identity Card/
Status
Correspondence Address
Telephone Number
Chinese
Certificate of
Incorporation* Number
* Delete if not applicable.
† Including the applicant.
[Subsidiary]