Document ID: chunk:federal_register_of_legislation:F2006L03941:body:0:p3
Version: federal_register_of_legislation:F2006L03941
Segment Type: other
Provision Reference: 
Character Range: 6843–11311

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
                                                                                              °/       '/       "/ S                      °/       '/       "/ E
  6. Facility 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 23

   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 Consumption 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 ACQUIRED, RETAINED, USED AND/OR TRANSFERRED

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

14. Structural formula

15. CAS registry number (if assigned)

16. Quantity likely to be acquired

17. Details of supplier

18. Maximum quantity likely to be retained

19. Quantity likely to be used

20. Nature of Use                                           Please describe (in words):

   21. Quantity likely to be transferred from the facility

22. Details of recipient of any likely transfer

Section C.  Confidentiality

23.  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.......

Production, processing or consumption of Schedule 2 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
(sufficient 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:
                                                                                                 deg/min/sec           °/         '/          "/ E
                                                                     °/         '/         "/