Professional Documents
Culture Documents
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521,/1000
194788
AWAL, 'I'APAK (PA!,)
PERMOHONAN
SENARAI
sei)erli eli
pcrmohonan tidak
NOTA PENTING!
Binding' )
yang
semasa
eli
Bernml
Deriu
f.
f',t.~
BORANG AS PAT.
FORM AS PAT
OF NEVV FACTORY
ARAS 3 - i, BLOCK C4
62662 PUTRAjA YA
TEL.: 03 - 88858200
FAKS: 03 - 8888998i
OF NEW FACiONV
1.
2,
Nama pemilik/Lembaga
Name of owner/Board of Directors:
3.
Telefon
Telephone:
4.
5.
(i)
(ii)
lawatan Pemohon:
Designation of Applicant:
(ii i)
Alamat Pemohon:
Address of Applicant:
Telefon ___,_,
Telephone:
6.
Nama dan
Perunding
Name and
Appointed
Faks: ___"________'~,__,,~,,
Fax
----,--,~,-,-,---,
~---'''---,,-----
---,~,,,-,~~~-,
Alamat
Yang Dilantik:
Address of
Consultant:
Alamat Ki
Address of Factory:
-'-'-~'-'--~'''--~'----~----'~'--'~'-'
Telefon _ _ _ _ _ __
Telephone:
Faks:,_________
Fax
AS P!\ I
Garis Li
CeliiS
Latitude:
Longillle/e:
kkan keciuciu(1n kil,lng, kawilsan pCfunlilh;1I1, illl1l',lIi/suligai
1 km jcjari dari
k kil'lIlg.
*Kembarkan satu
lain-lain penggunaan
Attach a site plan
the
within 7 km radius of the site.
Is the
Ya
Yes
Tic]flk
.No
(i)
----(ii)
Sila
~--------
and
..
12.
(il
nakan
Unit l<uantiti
Kuantiti
Unit of
Ian
Per Month
------
13,
cli1/l
tapak cadangan terletak cii clalam kiiwaS(11l pClinciustl-iiln Yfll1g d iWilfl;111I1 <
10.
11.
BUllIl"
(ii)
~-
--
....
Nama
Name
Unit Kuantiti
Unit of
Kuantiti
Ian
Per Month
!\S Pin
uaran:
14.
Nama
Name
(i)
l(u,1I1[i:i Scbulal1
C)u<lntity Per Month
Unit /(uantiti
Unit or
Purata
Average
Maksirnum
Maxi/nulII
(ii) Masa
Purala
Average
Mabinlllill
A1aximuln
Semi
Per
Syif Sehari:
or Shifts Per
---~-'"~
Sebulan
Per ivlonth
Setahun
Per Year
16.
Terangkan
Describe in
---------.-----~---
17.
I(egunaan Air
Water
... -
- - -....
Punea
Source
(i)
Air ,Iviinum:
Water:
(ii)
Air Pr'oses:
Process Water:
..
....
_--
k:
Lain-Lain:
Others:
Elektrik
Alat-Alat
- - _...._----_._-
- - _ ........__ ..._-_..,._--
Alat-Alat
Bilangan
Quantity
(i)
Dandang:
[Jaffer:
(ii)
Dapur:
Cookel/Oven:
Hahanapi
of Fuel
(f i i)
Generator:
(iv) insinerator:
Incinerator:
(v)
(nyatakan)
Others (specify):
20.
Dal'i rajah a I iran bagi sernu a proses pengel Llaral1, 511a tll njukkan tempat pe lepasan pencemaran dan
From the (Iowdiagrarns
show the
of emission
and
of pollutants
(i)
Tempat
Points of Emmision/
..
1.
(i)
(iii)
Jenisnya
Types of
Pollutants
I<uantiti
Quantity
~~---
AcJakah
aan tuan
Do the processes
Ya
Yes
(i i)
(ii)
Kalau ya , sebutkan
If yes, specify the
buangan
I?
Tidak
No
h, pelupusan dan j
of disposal and also
site
------------ -------------_._--
..
--
;\SI'!\T
(i i i)
hunyi hising
in [he (ae/or y.
Noise
Norse Pmvcr
~~~~--~-------
MAlKLUMAT flVM!BiAHA'I\J
ADDITfONALIN:Fo,RM'ATJON
22.
lampiran.
Pelan susunatur
Plan
I, the undersigned, certify that the information given in this application form is to the best of my knowledge and
belief true and correct.
Tarikh: _______
Date
Designation
Ada
Yes
Perb'ra
Subject
Lengkap
Complete
n Ill;)ksuci
PA
lellgkap.
Tiada
lengkap
Incomplete
No