Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Company Government Entity Establishment Other Individual 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 Industrial Agricultural Construction Service Other Medical Educational CommercialOther (please specify) Brief Description of the Activity and Its NatureActivity Status Planned (New Project) Existing Under ConstructionProject 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 Preparation / Review of Environmental Impact Assessment (EIA) Compliance Assessment with Environmental Regulations Support in Obtaining Environmental Permit Preparation of Environmental Register Handling Environmental Violation or Notice General Environmental Consultation Environmental Classification (Category A, B, C) Preparation of Environmental Management Plan (EMP) Other Environmental Measurements (Air – Water – Noise – Soil)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Municipality National Center for Environmental Compliance (NCEC) Other Civil Defense Ministry of Industry 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? Industrial / sanitary wastewater Solid waste Noise Other Air emissions Chemicals Hazardous waste OdorsAttached Documents (Optional)Attached Documents (Optional) Air emissions Site plan Activity license Commercial registration Previous environmental studies Site photos Site layout / drawings Industrial / sanitary wastewaterAdditional 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
