EHS ENP-03 ENF-03a

ENVIRONMENTAL PERMIT APPLICATION FORM

Type of Permit Application (please tick the appropriate box/es)

Harbor / Open Sea Discharge Permit Air Emission Permit

Irrigation Permit

General Information

Name of the Company :

Type of Activity :
Plot Location Number/s :
Free Zone License No. : Date of Expiry :
Contact Person :
Designation : Contact Nos. :
Email Address :

REVISION: 00 July 2010 Page 1 of 4

Note: Please refer to www.ehss.ae to ensure that this document is current and applicable
EHS ENP-03 ENF-03a

Air Emission Permit

Combustion Source Volatile Organics Source

Sources of Air Emission
Process Source

Number of Emission Source/s

Type of Air Emission

Continuous Batch
Discharge

Number of Hours Operated in a

Year

Type of Fuel Used

% Sulfur of Fuel
Combustion Source Previous Year Fuel Consumption
Fuel Storage Capacity
Fuel Storage Type

Stack Emission Analysis Report from accredited third party

laboratory (http://www.dac.dm.ae)
Documents to be submitted
Fuel Analysis Report from fuel supplier (if applicable)
Others (if any; as required)

Minimum parameters to be tested for each type of emission sources

(others can be added as required by EHS Environment Department)
Carbon Monoxide, Nitrogen Oxides, Sulfur Dioxide,
Combustion Source
Total Particulate Matter
Minimum parameters shall be based on the type of raw materials
Process Source
input
Volatile Organics Source Total Volatile Organic Compounds, Total Particulate Matter

REVISION: 00 July 2010 Page 2 of 4

Note: Please refer to www.ehss.ae to ensure that this document is current and applicable
EHS ENP-03 ENF-03a

Harbor / Open Sea Discharge Permit

Discharge Outfall Location Harbor Water Open Sea

Type of Treatment Process

Rated Capacity of Treatment

Facility

Industrial Domestic
Description of Waste Type
Others (please specify)

Method for Collection /

Storage of Waste

Type of Treated Effluent

Continuous Batch
Discharge

Maximum Quantity of
Discharged Treated Effluent m3 / day

JAFZA Manhole ID No.

(Location of Discharge)

Treated Water Analysis Report from accredited third party

Documents to be submitted laboratory (http://www.dac.dm.ae)
Others (if any; as required)

REVISION: 00 July 2010 Page 3 of 4

Note: Please refer to www.ehss.ae to ensure that this document is current and applicable
EHS ENP-03 ENF-03a

Irrigation Permit

Source of Irrigation Water

Type of Treatment Process

Quantity of Irrigation Water

Discharge m3

Number/s of Irrigation Water

Storage Tank/s

Capacity of each of Irrigation

Water Storage Tank/s

Irrigation Water Analysis Report from accredited third party

Documents to be submitted laboratory (http://www.dac.dm.ae)
Others (if any; as required)

REVISION: 00 July 2010 Page 4 of 4

Note: Please refer to www.ehss.ae to ensure that this document is current and applicable