Document ID: chunk:federal_register_of_legislation:F2006L03941:body:0:p2
Version: federal_register_of_legislation:F2006L03941
Segment Type: other
Provision Reference: 
Character Range: 3138–7390

of the applicant or notifier

.......................................................….... …............………..................................................
         (Signature)     (Full Name)

 Dated ......................................., 20........

To operate a facility producing Schedule 1 chemicals:  Research Facility
    -          Permit Application / Renewal Form
    -          Notification Form

Chemical Weapons (Prohibition) Act 1994 - sections 17(1), 20(1), 29(1)

PLEASE READ THE GUIDE TO THIS FORM BEFORE COMPLETING IT

Indicate whether this is an Application         or a Notification         for calendar year:

Section A.      Organisation/Institution operating facility
(ASNO reference:    Site code:   )
1. Facility name

   2. Name of the operator of the facility and principal place of business
   3. Postal address of facility
   4. Street address of facility

   5. Site location                                                         Latitude:                                  Longitude:
   co-ordinates                                                             deg/min/sec                                deg/min/sec
                                                                                               °/       '/       "/ S                      °/       '/       "/ E
   6. Building or Structure number, if any
7. Contact
8. Title
9. Contact Details                                                          tel:         fax:
   10. Principal Researcher
11. Contact Details                                                         tel:         fax:

If the form is being completed as a notification, and not a permit application, go to question 19

   12. In the initial application enclose, as Attachment A, a detailed technical description of the facility, including facility diagrams, an inventory of equipment and a description of other Schedule 1 chemicals used and/or stored at the facility.

         Section B Details of anticipated activities at the Research Facility with Schedule 1 chemicals for the calendar year for which the permit is sought

USE ONE COPY OF THIS PAGE FOR EACH SCHEDULE 1 CHEMICAL TO BE PRODUCED

   13. IUPAC chemical name or, if unknown,
   Schedule 1 family name

14. Structural formula

15. CAS registry number (if assigned)

16. Quantity anticipated to be produced

   17. Anticipated periods of production (indicate months when activity is expected)

   18. Brief description of the purpose of anticipated production

Section C.  Confidentiality

   19.  If there is any information in this form which you believe requires particular protection, describe that information against the appropriate classification:

classification
OPCW - Restricted
OPCW - Protected
OPCW - Highly Protected

Note:  The Chemical Weapons (Prohibition) Act prescribes penalties for the provision of false or misleading information.

Signed by/on behalf of the applicant or notifier

.......................................................….... …............………..................................................
         (Signature)     (Full Name)

 Dated ......................................., 20.......

To operate a facility acquiring, retaining, using and/or transferring Schedule 1 chemicals:  Consumption Facility
- Permit Application / Renewal Form
- Notification Form

Chemical Weapons (Prohibition) Act 1994 - sections 17(1), 20(1), 29(1)

PLEASE READ THE GUIDE TO THIS FORM BEFORE COMPLETING IT

Indicate whether this is an Application         or a Notification         for calendar year:

Section A.      Organisation/Institution operating facility
(ASNO reference:    Site code:   )
1. Facility name
  2. Name of the operator of the facility and principal place of business
  3. Postal address of facility operator
  4. Street address of facility
  5. Facility location                                                     Latitude:                                  Longitude:
  co-ordinates                                                             deg/min/sec                                deg/min/sec
                                                                                              °/       '/       "/