Document ID: chunk:federal_register_of_legislation:F2006L03941:body:0:p5
Version: federal_register_of_legislation:F2006L03941
Segment Type: other
Provision Reference: 
Character Range: 15009–19422

to be exported from the site, specify the importing countries, and indicate the typical concentration of the chemical in the product :  countries:

                                                                                                                                                                                                       concentration :                          %

25. If the Schedule 2 chemical (or a product containing it) is to be sold or transferred within Australia, specify the type of recipient, indicate the typical concentration of the Schedule 2 chemical in the product, and (if known) indicate the final product types :
       other industry         trader             other :   concentration :                     %
final product types:

26. Specify any other purpose for which the Schedule 2 chemical will be produced, processed or consumed:

Section E.  Confidentiality

27.  If there is any information in this form which you believe requires particular protection (eg. because unauthorised disclosure could harm your business interests), describe that information against the appropriate classification:

classification           current information  correct or update if necessary
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........

Production of Schedule 3 chemicals
    -          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

Application  / Notification for calendar year:

Section A.      Company or organisation operating facility (ASNO reference:                        )
                                           current information              correct or update if necessary
                                           (this column for ASNO use only)
  1. Name and principal place of business
  2. Postal address
  3. Contact
4. Title
5.                                         tel:                             fax:                            tel:   fax:

Section B.      Facility (plant site) (ASNO site code :                        )
                                       current information  correct or update if necessary
6. Name
7. Street address
(to uniquely identify the site)

8. Contact
9. Title
10.                                    tel:                 fax:                            tel:         fax:
11. Site location                      Latitude:                                            Latitude:
                                                               °/        '/         "/ S    deg/min/sec   °/         '/         "/ S
co-ordinates                           Longitude:                                           Longitude:
                                                                °/       '/        "/ E     deg/min/sec    °/         '/          "/ E
12. Number of relevant plants at site
13. Other chemicals produced at site

COPY THIS PAGE IF THE AVAILABLE SPACE IS NOT SUFFICIENT

Section C.      Details of each declarable plant producing Schedule 3 chemicals
Plant Site code :    Plant code:           (issued by ASNO)
                                  current information  correct or update if necessary
14. Plant name
15. Building / Structure Number                        Bldg:                      Structure:
16. Main activities at the plant                        Production    Processing    R&D
                                                        Consumption    Storage
                                                        Re-packaging, distribution
                                                       Other :

Section D.      Details of each Schedule 3 chemical to be produced
17. Chemical Name :
trade name :                  CAS No. :
                              18. Quantity Produced  +/-  19. Purpose of Production
anticip-ated for Permit Year  tonnes                 %     Sale or transfer to other industry