3. Qualified Engineer/Authorized Person

Name of Qualified Engineer/Authorized Person (Surname First)

[Subsidiary]

Correspondence Address

Telephone Number

Material† Prepared

4. Premises where the specified process is conducted

Name of the Premises (if any)

Address

English

Chinese

Title or Position

Correspondence Address

Telephone Number

F 24 CAP. 311] Air Pollution Control (Specified [1987 Ed.

Telephone Number

Processes) Regulations

Area of the Premises (m2)

Land Status

Name of Air Control Zone in which the Premises are Located

Business Registration No.

Certificate of Incorporation No.

No. of Employees in the Premises

Chinese

Contact Person in the Premises (Surname First)

English

† Including the plans and specifications mentioned in paragraphs 5 and 6.

Nature of Tenure

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