Application For Renewal of a Waste Licence

Form 1 -
Application For A Licence To Carry Out An Activity Prescribed By Section 192D of the Public Health Act.

1- Name *

2- Business Address *

3- Registered Address (if different) *

4- Can you please give details of your telephone number, fax number or email code.

4- Phone Number *

Fax number

If any

Email Address *

5- Please provide the expiry date and number of the licence that you wish to renew. *

6- Have any changes been made to your waste activities or processes listed in your original application Form 1? *

7- Have you or your organisation been fined, judicially or administratively reprimanded or otherwise suffered any sanction resulting from any failure to uphold its legal or contractual duties? *

Date *

Applicant will be required to sign application form prior to document being issued by the Agency.

I certify that the information contained in this Application is true to the best of my knowledge and belief. *

Yes

* obligatory fields