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 WhatsApp Email Phone Call Type of Activity Main Activity Type Industrial Construction Other Medical Agricultural Educational Commercial ServiceOther (please specify) Brief Description of the Activity and Its NatureActivity Status Under Construction Planned (New Project) ExistingProject Location Region / Governorate City Is the site located within Commercial Area Residential Area Mixed-Use Area Industrial Area Site Coordinates (if available)Type of Service Requested Is the site located within Other Support in Obtaining Environmental Permit Environmental Measurements (Air – Water – Noise – Soil) Environmental Classification (Category A, B, C) Preparation of Environmental Management Plan (EMP) General Environmental Consultation Preparation / Review of Environmental Impact Assessment (EIA) Handling Environmental Violation or Notice Preparation of Environmental Register Compliance Assessment with Environmental RegulationsOther (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Other Ministry of Industry National Center for Environmental Compliance (NCEC) Civil Defense Municipality Ministry of Environment, Water and AgricultureCurrent 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? Air emissions Other Industrial / sanitary wastewater Chemicals Hazardous waste Solid waste Noise OdorsAttached Documents (Optional)Attached Documents (Optional) Activity license Industrial / sanitary wastewater Air emissions Site plan Site layout / drawings Site photos Commercial registration Previous environmental studiesAdditional 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
