Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Establishment Company Government Entity Individual Other 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 Educational Service Industrial Commercial Construction Medical Other AgriculturalOther (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 Mixed-Use Area Residential Area Commercial Area Industrial Area Site Coordinates (if available)Type of Service Requested Is the site located within Environmental Classification (Category A, B, C) Handling Environmental Violation or Notice General Environmental Consultation Compliance Assessment with Environmental Regulations Support in Obtaining Environmental Permit Environmental Measurements (Air – Water – Noise – Soil) Preparation of Environmental Register Preparation / Review of Environmental Impact Assessment (EIA) Other Preparation of Environmental Management Plan (EMP)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Ministry of Environment, Water and Agriculture Municipality National Center for Environmental Compliance (NCEC) Civil Defense Ministry of Industry OtherCurrent 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? Industrial / sanitary wastewater Hazardous waste Other Air emissions Solid waste Noise Chemicals OdorsAttached Documents (Optional)Attached Documents (Optional) Site plan Air emissions Activity license Site photos Site layout / drawings Commercial registration Industrial / sanitary wastewater 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
