Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Establishment Government Entity Individual Other Company Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact WhatsApp Phone Call EmailType of Activity Main Activity Type Other Medical Construction Service Industrial Agricultural 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 Industrial Area Mixed-Use Area Site Coordinates (if available)Type of Service Requested Is the site located within General Environmental Consultation Preparation of Environmental Register Preparation of Environmental Management Plan (EMP) Handling Environmental Violation or Notice Compliance Assessment with Environmental Regulations Environmental Classification (Category A, B, C) Preparation / Review of Environmental Impact Assessment (EIA) Support in Obtaining Environmental Permit Environmental Measurements (Air – Water – Noise – Soil) Other Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Municipality Other National Center for Environmental Compliance (NCEC) Civil Defense Ministry of Environment, Water and Agriculture Ministry of IndustryCurrent 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? Yes NO If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Chemicals Hazardous waste Air emissions Other Noise Solid waste Industrial / sanitary wastewater OdorsAttached Documents (Optional)Attached Documents (Optional) Site plan Site layout / drawings Previous environmental studies Air emissions Site photos Commercial registration Industrial / sanitary wastewater Activity licenseAdditional 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
