Application form
Environmental Protection Regulation 2008
Exemption for transport of trackable waste
This form is to be used to submit an application for exemption for transport of trackable waste, under section
81Y of the Environmental Protection Regulation 2008. Approvals must be granted before you can proceed
lawfully with your project and any associated activities. Please read the information sheets and any guidelines
included with your application kit to understand the environmental management and conservation issues,
policies and procedures that relate to the activities proposed.
1. Applicant name/contact person
Name
2. Trading as
Name
3. ACN/ARBN
ACN/ARBN
All bodies registered under Corporations Law will have an Australian Company Number (ACN), except for some foreign
bodies which will have an Australian Registered Body Number (ARBN).
4. Applicant address and contact details
Street address/registered office
Telephone
Fax/mobile
Email
Page 1 of 3 • 140917 • EM1991 • Version 3
ABN 46 640 294 485
Application form
Exemption for transport for trackable waste
5. Specific information requirements
5.1 Name and type of waste
5.2 Provide information to satisfy the administrating authority that the waste does not show any
environmentally significant characteristics?
5.3 You are required to provide a report of initial assessment with this application. Please tick the boxes
below to show you have included the information requested.
Use the checklist as a guide to having attached all essential information in your application. Applicants should
read carefully the information sheet Exemption of trackable waste.
Type of waste
Type of contaminant(s)
Sampling and analysis program to determine properties and concentration
Justification for sampling frequency
Level/concentration of contaminant(s)
NATA registered laboratory
Whether the waste is a dangerous good
Review of results against Schedule 2G of the Environmental Protection Regulation 2008
Page 2 of 3 • 140917 • EM1991 • Version 3
Department of Environment and Heritage Protection
Application form
Exemption for transport for trackable waste
6. Declaration
Read carefully through the certification before signing. Note that the ‘responsible person’ or their appointed
signatory must sign this form.
 I do solemnly and sincerely declare that the information provided is true and correct to the best of my
knowledge and I make this solemn declaration conscientiously believing the same to be true and by
virtue of the provision of the Oaths Act 1867.
 I am aware that it is an offence under section 480 of the Environmental Protection Act 1994, to give the
administering authority a document containing information that I know is false or misleading in a
material particular.
 I understand that all information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
APPLICANT’S NAME
PRINT NAME OF APPOINTED SIGNATORY (IF APPLICABLE)
APPLICANT’S SIGNATURE/APPOINTED SIGNATORY’S SIGNATURE
DATE
7. Applicant checklist
Application form(s) completed and signed
Permit fees paid or enclosed
Supporting information and accreditation
Please return your completed application kit to:
Trackable Waste Regulation and Support
Department of Environment and Heritage Protection
GPO Box 2454
Brisbane Queensland 4001
attached
Enquiries: (07) 3330 5677
Facsimile: (07) 3330 5634
Email: waste.track@ehp.qld.gov.au
Page 3 of 3 • 140917 • EM1991 • Version 3
Department of Environment and Heritage Protection