Document ID: chunk:federal_register_of_legislation:F2006L03941:body:0:p6
Version: federal_register_of_legislation:F2006L03941
Segment Type: other
Provision Reference: 
Character Range: 19133–23489

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
                                                           In-line consumption as produced
                                                           Synthetic intermediate stored and/or used on site
                                                          Other :

Section E.     20.  Describe any information in this form which you believe requires protection
(eg. as unauthorised disclosure could harm your business interests), 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 facility operator:

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

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

FORM 4

Notification of a facility producing Unscheduled Discrete Organic Chemicals

Chemical Weapons (Prohibition) Act 1994 - section 29(1)

PLEASE READ THE GUIDE TO THIS FORM BEFORE COMPLETING IT

Notification of activities during 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 co-ordinates          Latitude:                                                     Latitude:
                                                                      °/      '/         "/ S         deg/min/sec            °/         '/         "/ S
                                        Longitude:                                                    Longitude:
                                                                     °/       '/         "/ E         deg/min/sec           °/         '/          "/ E
12. Number of relevant plants at site
13. Other chemicals produced at site
14. Other activities at the plant site                        production    processing    storage
                                                              consumption    research/ development
                                                              re-packaging, distribution
                                                             other :

(ASNO site code:                                       )

COPY THIS PAGE, OR USE AN ATTACHMENT, IF THE AVAILABLE SPACE IS NOT SUFFICIENT

Section C.     15. List unscheduled discrete organic chemicals (DOCs) produced at the site, with production figures for the calendar year in respect of which notification is made.  For a site producing many DOCs, chemically similar compounds may be grouped together - but do not group PSF with non-PSF chemicals.  In the right-most column indicate DOCs or groups that are PSF chemicals.
chemical name / group description  CAS number  production (tonnes)  PSF (y/n)
                                               100% by weight

Section D.      16. Name, and estimate total production of PSF chemicals, for each plant at the site where more than 30 tonnes of any individual PSF chemical were produced during the year notified.  In the right column, indicate whether production of any individual PSF chemical at the plant exceeded 200