Document 4264

Environmental Health Services
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APPLICATION FORM (DRY CLEANERS)
LOCAL AUTHORITY POLLUTION PREVENTION
AND CONTROL
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POLLUTION PREVENTION AND CONTROL ACT 1999
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POLLUTION PREVENTION AND CONTROL (ENGLAND AND WALES) REGULATIONS
2000 (AS AMENDED)
This is the application f o m for a permit to operate a dry cleaning installation (dry cleaners),
as defined in Schedule 7 of The Solvent Emissions (England and Wales) Regulations, 2004
SI 107.
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Before filling in this form please read the DEFRA guidance.
There are a number of other documents you may need to send us with your application.
Each time a request for a document is made in the application form, you will need to record
a reference number for the document or documents you are submitting in the space
provided on the form for this purpose. Please also mark the docurnent(s} clearly with this
reference number.
Please send the ORIGINAL and ONE COPY of this form and all other documentation to
assist in the processing of your application. We have made the application form as
straightfonvard as possible, but id you need to contact us you can do so in the following
ways:
IN WRITING:
The Environmental Protection Team
Envimnrnental Health Services
Reigate and 8anstead Borough Council
Town Hall
Castlefield Road
Reiga te
Surrey
RH2 OSH
BY TELEPHONE:
01737 2764000
WEBSITE:
w\rvw.reigate-banstead.gov.~k/publi~JEn~ir~nment/EHlEP
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The application documents must be accompanied by a cheque for £134, the correct
application fee for the year 200612007.
The completed application form and application fee will need to be submitted to the Council
at the above address. We recommend that you do sa either by hand and obtain a receipt,
or by post using special delivery.
1.
OPERATOR DETAILS
1.1
Name of the dry cleaners
I-2
Please give the address of the dry
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76
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8~3-173
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Telephone number of the dry cleaners: .....................................................................
Email Address: (this is not compulsory, but will help us to get information to you quickly)
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Ordnance Survey national grid reference 8 characters; T~Z~-Y,%
(for example SJ123 456, there are a number of internet mapping sites which will conveti a
Post Code to a grid reference)
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1.3
Existing authorisations or permits
Do you have an existing authorisalion or permit for the dry cleaners?
.........................................................................................................................
.........................................................................................................................
7.4
The Operator (The person who it is proposed will have control over the, dry cleaners, in
accordance with the permit (if granted))
Please provide the full name of the company or corporate body or the name of the sole
trader or the name of the partners.
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Tradinglbusiness name (if different)
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Registered Office address (or for sole traders and partnerships, your usual address for
'3 23173
0lZ73
Telephone number of the Registered Office ...............................................................
Company registration number
I.5
..............................................................................
Holding Companies
Is the operator a subsidiary of a holding company within the meaning of Section 736 of the
Companies Act 1985.
n'
NO?
YES? (Name of ultimate holding company)
.........................................................................................................................
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Ultimate holding company Registered Ofice address
Telephone number: .................................
............................
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Company h gist ration number:
1.6
.........................................
Who can we contact about your application?
It will help us to have someone who we can contact directly with any questions about your
application. The person you name should have the authority to act on behalf of the operator
of the dry cleaners. This could be an agent or consultant, if you have appointed one, rather
than the operator
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Name
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Position
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Address
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Telephone "urn ber
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3 Fax number .....................................
O!z? 3.
Email Address: (this is not compulsory, but will help us to get information to you quickly)
2.
ABOUT THE DRY CLEANERS
2.1
Please provide a plan, showing the location bf the dry cleaners.
Document Reference ..... .&.
2.2
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A plan of sufficient scale to show the internal layout of the dry cleaners, with the following
clearly marked:
(a) where the dry cleaning machines will belare installed
(b) where the dry cleaning solvents will belare stored
(c) where the dry cleaning residue will belare stored
Document Reference
2.3
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O.O.!...e.. ........................................................
A plan showing the location and run of any drains within the dry cleaners and in the
immediate area of the dry cleaners, which may be affected as a result of any potential
Volatile Organic Compound (VOC) release from the dry cleaning operations
Document Reference
1 1 a - I s C s \ G +
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3,
DRY CLEANING MATERIALS STORAGE AND EQUIPMENT
The following information is required to enable us to determine whether you will operate the
dry cleaners in such a way so as to ensure that all environmental requirements of the
Pollution Prevention and Control (PPC) Regulations are met.
3.1
Provide a descriptipn of the location and methods of storage of:
{a) dry cleaning solvents
(b) dry cleaning residue
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Document Reference .........................
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3.2
Provide details of the make, model, namelnum'ber, serial number, load capacity, date of
installation and type of dry cleaning solvent used.
3.3
Provide details, including a schedule of checking and maintenance procedures for each dry
cleaning machine. This should include the machine manufacturers' recommended operating
procedures, checking and maintenance requirements and any other additional procedures
undertaken by the operator. See attached sheet headed "Guidance for Routine
Maintenance".
Document Reference
3.4
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Provide details of any other activities carried out within the dry cleaners which involve the
use of organic solvents, in particular spot clean solutions, water proofing solutions and any
other solvents or solvent borne preparations.
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Document Reference ............................................................................................
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3.5
Provide details on the training and relevant qualifications regarding operating and
maintaining the dry cleaning machine in accordance with relevant guidance (see Process
Guidance Note 6/46 - Secretary of State's Guidance for Dry Cleaning)
Document Reference
3.6
50 P
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.................................................................
Specify how the product will be weighed and recorded both weekly and annually.
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Document Reference ........................
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3.7
Provide details on how the mass or volume'of solvent will be determined and recorded both
weekly and annually, (With regard to spot cleaning, the amount of solvent used wilj only
need to be determined annualEy, because the amount used is so lowm)
Document Reference
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4
Risk Phrase Solvents
Are any substances or preparations which because of their VOC content are required to
carry one or more of the following risk phrases used within the dry cleaners:
R45 - May cause cancer
R46 - May cause heritable genetic damage
R49 - May cause cancer by inhalation
R60 - May impair fertility
R61 - May cause harm to the unborn child
El
Yes
(Details of the risk phrases of the materials used can be found on the otiginal suppliers
packaging and in the Materials Safety Dafa Sheet (MSDS) fw the product).
If your answer to 3.8 is Yes, please provide details of how and why these risk phrase
materials are used and how the requirements of the amendment 1C of Schedule 1 of The
Solvent Emissions (England and Wales) Regulations, 2004 SI 107, substitution, control and
limiting of emjssions of risk phrase malerials will be met.
Document Reference .............................................................................................
ADDITIONAL INFORMATION
Please supply any additional information you would like us to take account of in considering
this application
Document Reference
.............................................................................................
APPLICATION FEE
Please state the amount enclosed as an application fee for this installation
Cheques shoujd be made payable to Reigate and Banstead Borough Council
We will confirm receipt of the application fee when we write to you aaknnowledging your
application. Your application cannot be processed unless the application fee is enclosed,
Please give any company purchase order number or other reference you wish to be used in
relation to this fee.
ANNUAL CHARGES
If we grant you a permit, you will be required to pay an annual subsistence charge. 'Failure to
pay this charge will result in the revocation of your permit and you will not be able to operate
the Dry Cleaners
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Please provide details of the address you wish invoices to be sent to, and details of
someone we may contact about fees and charqes.
Name:
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Pos~tron:
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Address: .......................................................
9...
01-3- e37-73
......................................................
... .................
Email address: (this is not campullsory, but will help us to get information to you quickly)
Telephone number:
7.
COMMERCIAL CONFIDENTIALITY
7.1
Is there any information in the application that you wish to justify being kept from the public
register on the grounds of commercial confidentiality?
Yes
Please provide full justification, considering the definition of commercial confidentiality within
the PPC Regulations.
Document Reference
8.
.............................................................................................
DATA PROTECTION
The information you give will be used by this authority to process your application. It will be
placed an the relevant public register and used to monitor compliance with the permit
conditions. We may also use and or disclose any of the information you provide in order to:
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*
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consult with the public, public bodies and other organisations,
carry out statistical analysis, research and development of environmental issues,
provide public register information to enquirers,
investigate possible breaches of environmental law and take any resulting action,
prevent breaches of environmental law,
assess customer satisfaction and improve our service.
Information that does not need to be on the public register may be released under
the Environmental Information Regulations 2004.
We may pass on the information to agentstrepresentatives who we ask to do any of these
things on our behalf.
It is an offence under Regulation 32 of the PPC Regulations, for the purpose of obtaining a
permit (for you or anyone else) to:
make a false statement which you know to be false or misleading in a material
particular,
recklessly make a statement which is false or misleading in a material particular.
If you do make a false statement
we may prosecute you, and
if you are convicted, you are liable to a fine or imprisonment (or both).
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DECLARATION
9.1
Signature of current operator(s)*
I-certify
that the information in this application is correct. FlWe apply for a permit in
respect of the particulars described in this application (including supporting documentation)
Ilwe have supplied.
please note that each individual operator must sign the declaration themselves, even if an
agent is acting on their behalf.
For the application from:
Installationname
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sup^&&
3% ~ W N L ~ S
.....................
Signature
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Name
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Position
Date
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Signature
.........................................................................................
Name
..........................................................................................
Position
..........................................................................................
Date
..........................................................................................
* Where more than one person is defined as the operator, all should sign. Mere a company
or other body corporate, an authorised person should sign and provide evidence of authority
from the board of the company or body corporate.
FOR LOCAL AUTHORIW USE
........................................
s ~ ~ ~ ~ Date' received
P A.................................
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Officer Reference .................................
Installation Reference
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Form (July 2006) FINAL.doc
7
APPLICANT'S SUBMISSION SEPARATOR SHEET
Paragraph Reference....................... -2.2.. ........
Document Reference ........ - 13 0-001A.. ..
me following are labelled on the plan:
A ..........Dry cleaning Machine
I3.......Perchlorethylene storage
C.. ............ Storage of residues
D.. ... Drain runs (not affected )
APPLICANT" SSTS-BMISSIONSEPARATOR SHEET
P m g r a ~ hReference...... ...2.1. .............. ... ... ....
Document Reference ... ...OJS Map showing location of :
Supreme Dry Cleaners
76 Brighton Rd.,
Horley,
Surrey RH6 754
Siteplan" I : I 250
~rcduced07 Aug 2[XW from ORlnawa Survey dgital
data and inowporating surveyed revlston
ava~lablaatthis date. @ ~ m w CnM06.
Rvroduction in A d e or h pan is fmhibifed
mthout the plkr permksm of Ordnance Survw
Ordnance Survsy ard Itw aS symbol are r s g i n d
trade maris &Snepbn a aade markof
Ordnance S
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ho
mapping wv of
Grmt Bmam.
Manbna1 Grid shaet d e m at cmtm
d this Sitephn: T02843NW
by The BMdiding Centre
S a d Number. MX)57800
mPLICA_NT'S SUBMlSSlON SEPARATOR S E E T
Paragraph Reference.........3.4. .. ... ............... ... .
Document Reference ...... Supreme 004
Data Sheets for all spottingl proofmg chemicals, and Perc, are enclosed.
Perchlorethylene
Ammonia solution
Ready Strip
Tam1
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01
Colour
Rostol
Tintol
Devantol Super
Secapur Dry Master
Devantol Soft
These are entered on the appropriate sheet when new and added to any still in stock. The use
o f the spotting chemicals is totalled annually
I
Ist~&06107
Volume Replaced /
I
Spotting 1 Proofing Chemicals
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Volume-in- stock-.
Ammonia-Soln.
-Ready Strip
Tanol
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Colour
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-Tintol
Devantol Super
Secapur-Dry
- - Master
Devantol soft
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1Write in when new
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Yearly
VolumeUsed
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SAFETY DATA SHEET
Textile Care Supplies Ltd
32134 Whitehill Road .
Whitehill Ind. Estate
PRODUCT NAME:
SVPPLER:
, GIenrothes
Fife
KY6 2RW
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INGREDfENl' NAME
TETIUCflLOKOETIlYLEh'E:
CAS NO:
CObIPOSITION C O M m S :
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CASNo.
127-1 8.4
127-18.4
(c~s)
EUSK
(R NO,)
Xu,
40
COhTENfS HEALTIE
60-100%
ElKECS NUMBER: 205-500-4
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Po$$ibl~
Irrevcrsfblt etkeu.
Cureinogcn Categor). 3.
NOTE TO PHYSICJAN t Because mpid abrorpiion may,
occur through lungs if upinred and enuse iysrcmalic eff+u.
I h e decision of whe~herto induce vornirfng:or not should be
made '!b an attending physician. If lavage 1s ped9,t&d,,:''' '
suggwt cndolnchta1 andlot oesophagca! con(ml.1:~ D a n ~ i r
from lung spiralion must b t weighed against toxiFtly;;phta
mnsidcn'ng empl~ingthe stomach. If burn is presenl,'l&z as
my thermal burn. afrer decbnlamination. Exposvrc may
increase myocardial Im'rabltiry. Do not give
s~mpn~harnimetlc
drugs unless sbsoludy nemssorv, No
specific antidote. Supponive care. Treatmen&based on
judgcmcnt of physician in response to reaclions of the paricnt.
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