Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Establishment Other Individual Company Government Entity 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 Other Construction Industrial Agricultural Service Medical Commercial EducationalOther (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 Commercial Area Residential Area Industrial Area Mixed-Use Area Site Coordinates (if available)Type of Service Requested Is the site located within Support in Obtaining Environmental Permit Environmental Classification (Category A, B, C) Compliance Assessment with Environmental Regulations Preparation of Environmental Management Plan (EMP) Preparation of Environmental Register Other Handling Environmental Violation or Notice Preparation / Review of Environmental Impact Assessment (EIA) General Environmental Consultation Environmental Measurements (Air – Water – Noise – Soil)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) National Center for Environmental Compliance (NCEC) Other Municipality Ministry of Environment, Water and Agriculture Civil Defense Ministry of IndustryCurrent Environmental Status of the Site Has an environmental permit been previously obtained? NO Yes Is there a previous Environmental Impact Assessment? Yes NOAre 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 Hazardous waste Noise Solid waste Other Air emissions Odors ChemicalsAttached Documents (Optional)Attached Documents (Optional) Site layout / drawings Activity license Air emissions Industrial / sanitary wastewater Site photos Commercial registration Previous environmental studies 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
