Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Company Individual Government Entity Other Establishment Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact Email Phone Call WhatsAppType of Activity Main Activity Type Educational Industrial Construction Agricultural Other Service Medical CommercialOther (please specify) Brief Description of the Activity and Its NatureActivity Status Existing Under Construction Planned (New Project)Project Location Region / Governorate City Is the site located within Residential Area Industrial Area Commercial Area Mixed-Use Area Site Coordinates (if available)Type of Service Requested Is the site located within Preparation of Environmental Register General Environmental Consultation Other Support in Obtaining Environmental Permit Preparation of Environmental Management Plan (EMP) Environmental Classification (Category A, B, C) Compliance Assessment with Environmental Regulations Handling Environmental Violation or Notice Preparation / Review of Environmental Impact Assessment (EIA) 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 Municipality Civil Defense Ministry of Industry National Center for Environmental Compliance (NCEC) OtherCurrent 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? Yes NO If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Industrial / sanitary wastewater Air emissions Noise Solid waste Hazardous waste Odors Chemicals OtherAttached Documents (Optional)Attached Documents (Optional) Activity license Commercial registration Air emissions Site layout / drawings Site photos Previous environmental studies Industrial / sanitary wastewater 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
