1964_WATER_POLLUTION_CONTROL_(GENERAL)_REGULATIONS — Page 34

D 34

CAP. 358]

Water Pollution Control (General) Regulations

[1988 Ed,

[Subsidiary]

GOVERNMENT OF HONG KONG

FORM 4

WATER POLLUTION CONTROL ORDINANCE

(Chapter 358)

Section 19(1)

Application for a licence for a discharge or deposit from industrial premises

To the Water Pollution Control Authority,

.... Control Zone.

SECTION A. GENERAL INFORMATION

OFFICIAL USE ONLY

Date received

APPLICANT

Further info. sought

Full name

Name in Chinese characters (if any)

Public notification

Sampling point approved

Date granted/ refused

In Register

ISIC No.

A2.

Renewal date

Fee received

CODE

WPCO/L/1/..........

Variation date

Variation code

Remarks

A3.

ID Card No./Business Registration No.

Address for correspondence

Telephone No

Capacity in which making application

INDUSTRIAL PREMISES IN WHICH DISCHARGE OR DEPOSIT WILL ORIGINATE

Name and location of building in which premises will be situated

Name and location of proposed premises (specify floor no. if in multi-storey building)

Beneficial owner of building in which premises will be situated

ISIC category number and name of industrial process to be carried on on the premises

Product(s) of proposed industrial process

Proposed date of commencement of discharge or deposit

INDUSTRIAL ENTERPRISE WHICH WILL CARRY ON THE INDUSTRIAL PROCESS ON THE PREMISES

Name of enterprise

Address and Business Registration No. of enterprise

Full name and capacity of manager of enterprise

ID Card No.

Address for correspondence

Telephone No.