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1. ORGANISATION
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Name
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Address
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Town
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Postal Code
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Country/land/region/Autonomous Community
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Contact person
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Telephone
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FAX
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E-mail
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Website
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Public access to the environmental statement or the updated environmental statement
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(a) printed form
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(b) electronic form
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Registration number
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Registration date
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Suspension date of registration
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Deletion date of registration
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Date of the next environmental statement
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Date of the next updated environmental statement
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Request for derogation pursuant to Article 7
YES – NO
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NACE Code of activities
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Number of employees
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Turnover or annual balance sheet
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2. SITE
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Name
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Address
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Postal Code
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Town
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Country land/region/Autonomous Community
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Contact person
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Telephone
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FAX
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…
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E-mail
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…
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Website
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…
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Public access to the environmental statement or the updated environmental statement
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(a) printed form
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…
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|
(b) electronic form
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…
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Registration number
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…
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Date of registration
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…
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Suspension date of registration
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…
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Deletion date of registration
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…
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Date of the next environmental statement
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…
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Date of the next updated environmental statement
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…
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Request for derogation pursuant to Article 7
YES – NO
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…
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NACE Code of activities
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…
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Number of Employees
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Turnover/or annual balance sheet
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3. ENVIRONMENTAL VERIFIER
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Name of environmental verifier
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Address
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Postal Code
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Town
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Country/land/region/Autonomous Community
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Telephone
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FAX
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E-mail
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Registration number of accreditation or licence
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Scope of accreditation or licence (NACE Codes)
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Accreditation or Licensing Body
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Done at … on …/…/20
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Signature of the representative of the organisation
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