Dust Control Schedule 1 application form for Certificate

I/We being a person intending to undertake an activity or operation to which the Control of Dust Regulations 2010 are applicable hereby apply for a Certificate of Approval.

1- Name *

Capacity *

Telephone Number *

Fax Number (if any)

Email Address *

Registered Address *

Principal Address of the business *

2- Site Office Address

Address *

Telephone Number *

Fax Number (if any)

Email Address *

3- Details of person in charge of the activity or operation

Name *

Position *

Mobile Tel No. *

4- Out of Hours Contact Details

State names, position and out of hours telephone numbers of personnel who may be contacted out of hours.

Name 1 *

Position 1 *

Mobile Tel No. 1 *

Name 2 *

Position 2 *

Mobile Tel No. 2 *

5- State the activity or operation for which a Certificate of Approval is sought. *

6- State the address or name of site in respect of which this application is made. *

This application must be submitted together with a Dust Control Plan as required by Regulation 4 of the Dust Control Regulations 2010 *

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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