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