Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Company Other Individual Government Entity Establishment Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact Phone Call WhatsApp EmailType of Activity Main Activity Type Medical Agricultural Industrial Service Commercial Construction Other EducationalOther (please specify) Brief Description of the Activity and Its NatureActivity Status Planned (New Project) Under Construction ExistingProject Location Region / Governorate City Is the site located within Residential Area Commercial Area Mixed-Use Area Industrial Area Site Coordinates (if available)Type of Service Requested Is the site located within Environmental Measurements (Air – Water – Noise – Soil) General Environmental Consultation Environmental Classification (Category A, B, C) Other Preparation of Environmental Management Plan (EMP) Preparation of Environmental Register Support in Obtaining Environmental Permit Compliance Assessment with Environmental Regulations Handling Environmental Violation or Notice Preparation / Review of Environmental Impact Assessment (EIA)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Other Municipality Civil Defense Ministry of Industry Ministry of Environment, Water and Agriculture National Center for Environmental Compliance (NCEC)Current Environmental Status of the Site Has an environmental permit been previously obtained? NO Yes 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? Air emissions Hazardous waste Odors Solid waste Industrial / sanitary wastewater Chemicals Other NoiseAttached Documents (Optional)Attached Documents (Optional) Site plan Industrial / sanitary wastewater Air emissions Site photos Previous environmental studies Activity license Site layout / drawings Commercial registrationAdditional 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
