Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Individual Establishment Other Company Government Entity Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact Phone Call Email WhatsAppType of Activity Main Activity Type Medical Industrial Educational Service Agricultural Commercial Other ConstructionOther (please specify) Brief Description of the Activity and Its NatureActivity Status Existing Planned (New Project) Under ConstructionProject Location Region / Governorate City Is the site located within Residential Area Mixed-Use Area Industrial Area Commercial Area Site Coordinates (if available)Type of Service Requested Is the site located within General Environmental Consultation Environmental Classification (Category A, B, C) Support in Obtaining Environmental Permit Preparation of Environmental Management Plan (EMP) Other Compliance Assessment with Environmental Regulations Handling Environmental Violation or Notice Preparation / Review of Environmental Impact Assessment (EIA) Preparation of Environmental Register Environmental Measurements (Air – Water – Noise – Soil)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Ministry of Environment, Water and Agriculture National Center for Environmental Compliance (NCEC) Municipality Other Ministry of Industry Civil DefenseCurrent Environmental Status of the Site Has an environmental permit been previously obtained? Yes NO Is there a previous Environmental Impact Assessment? NO YesAre there any environmental violations or observations? NO Yes If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Industrial / sanitary wastewater Odors Hazardous waste Air emissions Noise Solid waste Chemicals OtherAttached Documents (Optional)Attached Documents (Optional) Site layout / drawings Activity license Commercial registration Previous environmental studies Industrial / sanitary wastewater Site photos Air emissions Site planAdditional DetailsAdditional DetailsDeclarationI hereby declare that the information provided above is accurate and correct, and I agree to its use for the purpose of reviewing the request and contacting me regarding the requested service. I AgreeNamethe datesend
