1964_AIR_POLLUTION_CONTROL_(SPECIFIED_PROCESSES)_REGULATIONS — Page 7

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SECOND SCHEDULE

FORM 1

[regs. 4, 11, 12, 13 & 16.]

[reg. 4.]

AIR POLLUTION Control (SPECIFIED PROCESSES) REGULATIONS

APPLICATION FOR A LICENCE PURSUANT TO SECTION 14 OF THE AIR POLLUTION CONTROL ORDINANCE

1987 Ed.] Processes) Regulations Air Pollution Control (Specified

[CAP. 311

F 7

I/We* the undersigned hereby apply under section 14 of the Air Pollution Control Ordinance for a licence for the conduct of the undermentioned specified process and I/we* hereby declare that 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 the application.

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

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

To: The Authority

* Delete if not applicable.

† Including the applicant.

[Subsidiary]

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SECOND SCHEDULE FORM 1 [regs. 4, 11, 12, 13 & 16.] [reg. 4.] AIR POLLUTION Control (SPECIFIED PROCESSES) REGULATIONS APPLICATION FOR A LICENCE PURSUANT TO SECTION 14 OF THE AIR POLLUTION CONTROL ORDINANCE 1987 Ed.] Processes) Regulations Air Pollution Control (Specified [CAP. 311 F 7 1. I/We* the undersigned hereby apply under section 14 of the Air Pollution Control Ordinance for a licence for the conduct of the undermentioned specified process and I/we* hereby declare that 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 the application. I/We* enclose the application fee of $100. This application, including plans and specifications, comprises pages. Dated this day of 19 Signature of Applicant Name 2. Details of Owner(s)† Name of the Owner(s) (Surname First) English Identity Card/ Status Correspondence Address Telephone Number Chinese Certificate of Incorporation* Number To: The Authority * Delete if not applicable. † Including the applicant. i [Subsidiary]

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