Application for Registration of Operators forMobile Plant for Site Remediation
ID Card No
Building Entry Point Name
Form GBR 18.1
Environment and Resources AuthorityEnvironmental Permitting UnitHexagon House, Spencer Hill,Marsa, MRS 1441, Malta.
The requested information must be completed in full. Failure to provide adequate information will delay processing of the application.
For Office use only
Reference Number (GBR)
Personal details of applicant or contact person
1. Additional information
1.1 Type of remediation technology (Please tick - Additional information, including photos of equipment to be provided as Attachment 1)
Soil Vapour Extraction
1.2 Description of the main activities to be permitted. (Additional information including Process flow diagram to be provided as Attachment 2)
Titles of supplementary forms and documentation to be submitted
Tick when provided
Attachment 1: Additional information on treatment technology, including photos
Attachment 2: Additional information on activities, including Process flow diagram
Insert further documents as applicable
NB: The Authority may request any additional information it deems necessary to further process the application.
I apply for the environmental registration as indicated above, and declare that, to the best of my knowledge, all the information contained in this application and on the submitted supplementary forms and documentation is complete and correct. I also understand that any incomplete, fraudulent or misleading information will annul the application or registration, and may also incur any relevant penalties. I also declare that I have read the data protection clause below:
on behalf of/in my own name (in block letters)
Please read the following before signing - Data Protection Clause
In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), we will process any personal and/or sensitive data supplied on/in this application, request or notification form or subsequently supplied by yourself, whether orally or in writing, for all or any of the following:
- The proper processing of your application, request and/or notice as submitted- Verification of the information provided to our officers- Preventing, detecting and/or prosecuting fraud and any other criminal activity which the Authority is bound to report and/or act upon whilst meeting any other specific legal or regulatory obligations- Establishing, exercising or defending any legal action- Internal management, research and statistics, systems administration, the development and improvement of our services- The protection and promotion of our legitimate interests and the proper conduct of our obligations arising under any law or statutory instrument; and- To make public the necessary information as specified in the relevant law and/or instrument
Relevant data will be disclosed or shared as appropriate with all our employees and with other third parties if pertinent to any of the purposes listed above.Every field on the form is mandatory. Should you fail to fill in any mandatory field, we reserve the right to refuse the application. Should any field be inapplicable to your particular circumstances please mark that field with the letters "N/A".You have the right to require that we provide you with access to your personal data as well as the right to rectify, or, in appropriate circumstances, erase/edit any inaccurate, incomplete or immaterial personal data which is being processed. However, you are required to inform us immediately of any alterations relating to you personal data which we are processing.
By signing this form, you confirm that you are giving your explicit consent, in terms of the Data Protection Act, on behalf of yourself and all the other persons specified in this form for the Authority to process your respective personal information as outlined above and you confirm that you have brought this Data Protection notice tot eh attention of these other persons and obtained their respective consents.We undertake to implement appropriate measures and safeguard for the purpose of protecting the confidentiality, integrity and availability of all data processed.