EHS-EA001
Application Form
Environmental Protection Act 1994
Site-specific application for environmental authority
This approved form is to be used to make a site-specific application for an environmental Authority under
sections 124 and 125 of the Environmental Protection Act 1994 (EP Act) for an environmentally relevant
Activity (ERA).
The Following ERAs are administered by Local Government:
ERA No.
Short Description
Threshold
Asphalt Manufacturing
1000 tonne or more a year
12(1)
Plastic product manufacturing other than foam,
composite plastics or rigid fibre-reinforced plastics
50 tonne or more a year
12(2)
Plastic product manufacturing foam, composite plastics
or rigid fibre-reinforced plastics
5 tonne or more a year
Metal forming (hot forming)
10 000 tonnes per year
Metal Recovery
100 tonnes per day
Metal recovery without using a fragmentiser
100 tonnes or more per day, or
6
19
20(1)
20(2)(a)
10 000 tonnes or more per year
38(1)(a)
49
61(1)
Surface Coating – anodising, electroplating, enamelling or
galvanising
1 tonne to 100 tonnes per year
Boat Maintenance and repair
within 50 metres of a bed of
naturally occurring surface
waters
Waste incineration and thermal treatment
waste vegetation, clean paper or
cardboard
All applicants must be a registered suitable operator before carrying out an ERA. If you are not already
registered as a suitable operator, you need to apply to the Department of Environment & Heritage
Protection (EHP). EHP are contactable on 13 QGOV (13 74 68) or by email on palm@ehp.qld.gov.au. You
must apply fore, applying for the environmental authority.
Please note that your application for an environmental authority will not proceed until you have been
confirmed as a suitable operator.
If you would like to have a pre-lodgement meeting please contact Council’s Customer Service Centre prior
to lodging this application form.
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EHS-EA001
Checklist for making a site-specific application
You must complete this checklist before you continue with the application form.
If your application is for:


A single prescribed ERA
Multiple prescribed ERAs
fill in section 1
fill in section 1 and section 2
Depending on the results of your answers to the checklist questions, you may not be able to make an
application.
Checklist Questions
Section 1
Has a Development application
for the development been
made under the Sustainable
Planning Act 2009
Has a development application
been refused for this activity?
Result
☐ Yes
☐ No
☐ Yes
☐ No
If no, you cannot make an environmental authority
application until you have made a development application
for the material change of use. Both applications need to
be made together.
If yes, you cannot make an environmental authority
application. If a development application is refused the
environmental authority application must be refused.
☐ N/A
Is this an application for an ERA
devolved to Local Government
☐ Yes
☐ No
If no, you cannot make an application to Council for an
Environmental authority.
Is the application for a devolved ☐ Yes
ERA undertaken by a State of
☐ No
Local government entity
If yes, you cannot make and application to Council for an
Environmental Authority. Application needs to be made to
EHP.
Is the application for an mobile
and/or temporary activity
across local government areas
☐ Yes
If Yes, you cannot make an application to Council for an
Environmental Authority. Application needs to be made to
EHP.
Is the proposed activity carried
out at a facility with a nondevolved activity
☐ Yes
Section 2
Will the proposed ERAs be
carried out under the day to
day management of a single
responsible person (eg. a site
manager or operations
manager)
Are the places where the
proposed ERA will be carried
out close enough to make the
integrated day to day
management of the activities
feasible?
☐ No
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
If yes, you cannot make an application to Council for an
Environmental Authority. Application needs to be made to
EHP
If no, you cannot make a single environmental authority
application as you do not meet the definition of a single
integrated operation. All ERAs must be carried out under
the day to day management of single responsible person.
Separate applications will need to be made for the ERAs
that cannot be carried out as a single integrated operation.
If no, you cannot make a single environmental authority
application as you do not meet the definition of a single
integrated operation. All ERAs must be separated by
distances small enough so that the integrated day to day
management is feasible. Separate applications will need to
be made for the ERAs that cannot be carried out as a single
integrated operation
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EHS-EA001
Are all aspects of the proposed
ERAs operationally
interrelated?
☐ Yes
☐ No
Is this application for a new ERA
which will form part of an ERA ☐ Yes
project under an existing
☐ No
environmental authority?
If no, you cannot make a single environmental authority
application as you do not meet the definition of a single
integrated operation. All ERAs must be operationally
interrelated. For example if a Metal recovery ERA and
Surface Coating ERA were applied for, 1 ERA must be
dependent on the other ie. The operation of 1 cannot
function without the operation of the other. Separate
applications will need to be made for the ERAs that cannot
be carried out as a single integrated operation.
If yes, you cannot make an environmental authority
application for additional ERAs proposed to be carried out
as a part of a project. You can apply to amend the existing
environmental authority to add a new ERA to the ERA
project.
Definitions of terms used in this form
Where there is inconsistency between the definition of terms and the terms used in the EP Act, the terms in
the EP Act apply.
Environmentally
relevant activity (ERA)
A resource activity or a prescribed ERA
ERA Project
A prescribed ERA project or a resource project.
Mobile and
Temporary ERA
A prescribed ERA, other than an activity that is dredging material, extracting
rock or other material, or the incinerating of waste:
(a) Carried out at various locations using transportable plant or equipment,
including a vehicle
(b) That does not result in the building of any permanent structures or any
physical change of the landform at the locations (other than minor
alterations solely necessary for across and setup including, for example,
access ways, footings and temporary storage areas)
(c) Carried out at any 1 of the locations:
(d) For less than 28 days in a calendar year, or
(e) For 28 or more days in a calendar year only if the activity is necessarily
associated with, and is exclusively used in, the construction or demolition
phase of a project.
Prescribed ERA
An environmentally relevant activity that is not a resource activity and is
prescribed under section 19 of the EP Act.
Prescribed ERA
project
All prescribed ERAs carried out, or proposed to be carried out, as a single
integrated operation.
Registered suitable
operator
A person who, or a corporation which under section 318I of the EP Act has been
assessed as being suitable to carry out an ERA and has been listed on the
suitable operator register.
Single integrated
operation
Occurs when all the below criteria is met:
(a) The activities are carried out under the day-to-day management of a single
responsible individual, for example, as site manager or operations manager
(b) The activities are operationally interrelated
(c) The activities are, or will be carried out at 1 or more places
(d) the places where the activities are carried out are separated by distances
short enough to make feasible the integrated day-to-day management of
the activities.
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EHS-EA001
RESIDENTIAL
ADDRESS
OR
REGISTERED
BUSINESS ADDRESS (NOT A POST OFFICE BOX
ADDRESS)
Section 1 – Application Details
(PLEASE USE BLOCK LETTERS)
1. Applicant Details
INDIVIDUAL OR BUSINESS NAME
POSTAL ADDRESS (IF DIFFERENT FROM ABOVE)
TRADING NAME (IF RELEVANT)
CONTACT PERSON
ABN/ACN/AN (IF RELEVANT)
PHONE (WORK)
RESIDENTIAL
ADDRESS
OR
REGISTERED
BUSINESS ADDRESS (NOT A POST OFFICE BOX
ADDRESS)
PHONE (AFTER HOURS)
MOBILE
POSTAL ADDRESS (IF DIFFERENT FROM ABOVE)
FACSIMILE
CONTACT PERSON
EMAIL
PHONE (WORK)
3. Applicant Suitability
PHONE (AFTER HOURS)
Note: Where this application is a corporation
these questions applies to all the executive
officers of the corporation.
MOBILE
A. Have you been convicted of an offence under
this legislation? If yes provide details.
☐ No
FACSIMILE
☐ Yes (provide details)
B. Have you been issued with one or more
penalty infringement notices under this
legislation?
EMAIL
☐ No
When there is more than 1 applicant complete
Attachment 1 Appointment of principal applicant
by all joint applicants.
☐ Yes (provide details)
C. Have you ever had an environmental
authority or an equivalent authority or an
equivalent authority from another state or
country that was cancelled or suspended? If
yes, provide details about the authority,
when it was cancelled or suspended and the
reasons why.
2. Agent for applicant/address for
service
INDIVIDUAL OR BUSINESS NAME
TRADING NAME (IF RELEVANT)
☐ No
☐ Yes (Provide details)
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D. Have you ever breached any condition of an
environmental authority under this
legislation?
Have all applicants been registered as a suitable
operator?
APPLICANT NAME
☐ No
☐ Yes (Provide details)
SUITABLE OPERATION REGISTRATOIN STATUS
E. Have you ever been issued with an
environmental protection order under this
legislation?
Tick the box that applies and provide any other
requested detail.
☐ I am a registered suitable operator. You
must provide your suitable operator
registration number below
☐ No
☐ Yes (Provide details)
F. Have you been convicted of any offence
under environmental legislation in another
state or country?
SUITABLE
NUMBER
OPERATOR
REGISTRATION
☐ No
☐ I have lodged an application to be registered
suitable operator and am waiting for it to be
decided.
☐ Yes (Provide details)
G. Do you have any formal qualifications that
may be relevant to complying with conditions
of an environmental authority?
☐ I am not an existing registered suitable
operator and I have not yet lodged an
application to become a registered suitable
operator. You must contact EHP and make
an application to become a registered
suitable operator, otherwise this site-specific
application may be rejected as incomplete.
☐ No
☐ Yes (Provide details)
H. Have you owned or operated a business with
activities similar to that for which you are
making this application? If yes, include
details about size, location and nature of the
operation.
NOTE: If you will be lodging the suitable
operator application form please lodge it
to EHP Prior to this application.
☐ No
☐ Yes (Provide details)
I.
J.
Section 3 – Prescribed ERA
details
Do you have knowledge of environmental
protection legislation or any particular
knowledge of environmental issues and the
local areas that may be relevant to the
activities to be conducted under the permit?
5. Type of ERA Application
☐ A single prescribed ERA at a fixed Location
☐ No
☐ 2 or more prescribed ERAs at a fixed location
☐ Yes (Provide details)
☐ A mobile and temporary ERA with
Toowoomba Regional Council area only
Do any of your previous roles and
responsibilities provide you with knowledge
that may be relevant to you application?
6. Prescribed ERA/s to which the
application applies
☐ No
1. ERA NUMBER
☐ Yes (Provide details)
Section 2 – Registered suitable
operator
NAME OF ERA
4. Suitable Operators
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EHS-EA001
THRESHOLD
Area of Operation (eg. Oakey, Toowoomba,
Greenmount
2. ERA NUMBER
NAME OF ERA
THRESHOLD
3. ERA NUMBER
NAME OF ERA
9. Related Approvals
THRESHOLD
☐ I have made this application in conjunction
with my development Application
☐ a development approval has been granted,
state your development approval number
7. Fixed ERA Location
Fill out the details of the fixed location where the
ERA/s will be carried out.
STREET NUMBER
☐ I have made an application for a
development approval but it has not been
granted
STREET NAME
APPLICATION NUMBER
SUBURB/TOWN
DATE APPLICATION LODGED
POSTCODE
APPROVAL STATUS
LOT/PLAN(S)
8. Mobile
10. Take effect Date
and
Temporary
Do you want the environmental authority to take
effect on a nominated date or event?
ERA
☐ Yes (nominate the date or event below)
Location
For a mobile and temporary prescribed ERA
being conducted within Toowoomba Regional
Council only , provide details of the area of
operation below.
☐ No
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EHS-EA001
☐ By Mail
Section 4 – Environmental
Impact and supporting
information
Enclose a Cheque or Money order made
payable to Toowoomba Regional Council and
please mail to:
Toowoomba Regional Council
PO Box 3021
TOOWOOMBA VILLAGE FAIR QLD 4350
11. Environmental impact
You must provide an assessment of the likely
impact of each ERA on environmental values,
including:

Please ensure that you return your completed
form with payment.
A description of the environmental values
likely to be affected by each relevant
activity

Details of any emissions or releases likely
to be generated by each relevant activity

A description of the risk and likely
magnitude
of
impacts
on
the
environmental values

Details of the management practices
proposed to be implemented to prevent
or minimise adverse impacts
Section 6 – Declaration
Note: If you have not told the truth in this
application you may be prosecuted.
I declare that:
 I am the applicant or an authorised signatory
for the applicant.
 The information provided is true and correct to
the best of my knowledge. I understand that it
is an offence under section 480 of the
Environmental Protection Act 1994 to give to
Toowoomba Regional Council (TRC) or an
authorised person a document containing
information that I know is false, misleading or
incomplete in a material particular.
☐ Tick to indicate that an assessment of the
environmental impact and provision of
specific supporting information has been
attached.
 I understand that all information supplied on
or with this application form may result in the
application being refused.
12. Waste Management
A description of the proposed measures for
minimising and managing waste generated by the
ERAs must be attached
 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.
☐ Tick to indicate attachment
Section 5 – Payment of Fees
 I understand that I am responsible for
managing the environmental impacts of these
activities, and that approval of this application
is not an endorsement by
TRC of the
effectiveness of management practices
proposed or implemented.
Please refer to the schedule of fees to obtain the
application fee relevant to this application.
If your application is approved the first annual fee
must be paid within 20 business days of the
environmental authority taking effect. Operation
of the ERA cannot commence until the annual fee
is paid.
APPLICANT’S NAME
(Please select the payment method below)
☐ In person
SIGNATURE
Cash, cheque, money order, EFTPOS,
Mastercard or Visa. Present this notice to
Council’s Customer Service Branch at one of
our Customer Service Centres, 8.30am to 5pm
weekdays (except public holidays).
POSITION OF SIGNATORY
DATE
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EHS-EA001
JOINT APPLICANT NAME (IF APPLICABLE)
Section 8 – Submission
Please submit your completed application kit to:
Toowoomba Regional Council
PO Box 3021
TOOWOOMBA VILLAGE FAIR QLD 4350
JOINT APPLICANT SIGNATURE (IF APPLICABLE)
Or
JOINT APPLICANT NAME (IF APPLICABLE)
In person to one of Council’s Customer
Service Branch at one of our Customer
Service Centres, 8.30am to 5pm
weekdays (except public holidays).
JOINT APPLICANT SIGNATURE (IF APPLICABLE)
Section 9 – Privacy statement
Toowoomba Regional Council is committed to
protecting the privacy, accuracy and security of
your personal information in accordance with the
Information Privacy Act 2009.
Section 7 – Applicant Checklist
☐ Application form has been singed and
completed.
☐ Attachment 1: Appointment of principal
applicant by all joint applicants has been
signed and completed (if applicable).
Council is collecting your personal information in
accordance with the Environmental Protection
Act 1994 in order to assess your application
under that Act. The information will only be
accessed by authorised employees within
Council. Some of this information may be shared
with Department of Environment and Heritage
Protection. Your information will not be given to
any other person or agency unless you have given
us permission or we are authorised or required
by law.
☐ Section 3: additional details have been
attached with a description of the land where
ERA/s will be carried out (if required).
☐ Question 9: Information for assessment of
environmental impacts attached
☐ Question 10: Details of waste management
attached
All information supplied on this form may be
disclosed publicly in accordance with the Right to
Information Act 2009 and Evidence Act 1977. For
queries about privacy matters contact Council’s
Customer Service 131 872.
☐ Fees paid or enclosed.
All requested information must be provided with
this application, otherwise it will not be
considered properly made under section 127 of
the EP Act and assessment cannot commence.
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EHS-EA001
ATTACHMENT 1
APPOINTMENT OF PRINCIPAL APPLICANT BY ALL JOINT APPLICANTS
We being the joint applicants for this environmental authority, hereby nominate the following as the
principal applicant
Print name of principal applicant
Name/Company
Signatory name
ABN/CAN/AN
Signatory position
Signature
Date
Name/Company
Signatory name
ABN/CAN/AN
Signatory position
Signature
Date
Name/Company
ABN/CAN/AN
Signatory name
Signatory position
Signature
Date
Name/Company
ABN/CAN/AN
Signatory name
Signatory position
Signature
Date
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EHS-EA001
ATTACHMENT 2
Environmental impact assessment
Activity Details
Describe the type of work and services performed by your business.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_____________________________________________
____
Environmental Management
Are discharges to water that potentially cause contamination managed?
☐
No
☐
Yes
Specify __________________________________
Is stormwater protected from contamination?
☐
No
☐
Yes
Specify __________________________________
Are direct or indirect discharges to groundwater that potentially cause contamination managed?
☐ No ☐ Yes Specify __________________________________
Are noise and vibration emissions impacting on the surrounding environment and ecosystems managed?
☐
No
☐
Yes
Specify __________________________________
Are direct and indirect discharges to land that potentially cause contamination managed?
☐
No
☐
Yes
Specify __________________________________
Is waste generated by the activity managed to prevent any adverse impact on the environment?
☐
No
☐
Yes
Specify __________________________________
Do you have a Site Management Plan (including equipment maintenance, practices and procedures) to
prevent pollution or contamination during the normal operations of the activity?
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EHS-EA001
☐ No
☐ Yes
If Yes, is it documented?
☐ No
☐ Yes
(provide a copy)
Do you have an Emergency Response Plan that includes practices and procedures to prevent pollution or
contamination during an emergency situation?
☐ No
☐ Yes
If Yes, is it documented?
☐ No
☐ Yes
(provide a copy)
Do you have any other environmental reports or assessments pertaining to your business? (eg
Environmental Impact Statement)
☐ No
☐ Yes
If Yes provide a copy
Are noise and vibration emissions impacting on people’s ability to sleep, study, learn and be involved in
recreation, including relaxation and conversation managed?
☐
No
☐
Yes
Specify __________________________________
Does this activity generate any liquid waste?
☐ No
☐ Yes
Specify
a. Do you discharge liquid waste to the sewer?
☐
No ☐
Yes
If Yes, does the property owner have a Trade Waste Permit?
☐
No ☐ Yes
Provide permit No:
b. Does a contractor remove any liquid waste from the premises?
☐
No
☐
Yes
Site Plan
A site plan (a scaled drawing or sketch plan with dimensions) should accompany this application and
include the following details:
 Adjacent land uses
 Position of the building relative to the site boundaries
 Location type and height of site fencing or other buffers
 Location of all noise generating (both stationary and mobile) equipment
 Location and type of light source (eg showrooms, security, advertising lights)
 Location of all stormwater drain discharge points (to either stormwater system, natural
waterway or canal)
 Location of all other waste sources (eg gaseous emissions such as overspray etc)
 Location of sewer entry point
SEE EXAMPLE PLAN ON THE BACK OF THE LAST PAGE.
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EHS-EA001
Locality Details
Are the premises located within 500 metres of the following areas?
a.
Hospitals, schools or residential buildings
☐ No
b.
Indicate approximate distance:
___
Waterbodies (creeks, rivers, lakes, water supply catchments)
☐ No
C.
☐ Yes
☐ Yes
Indicate approximate distance:
__
Other sensitive land uses (community parks, children's day care centres, etc)
☐No
☐ Yes
Specify and indicate approximate distance:
Operating Times
What are the hours of operation for this activity?
Mon-Fri
Start . . . . . . . . . am/pm Finish . . . . . . . . . . . am/pm
Saturday
Start . . . . . . . . . am/pm Finish . . . . . . . . . . . am/pm
Sunday
Start . . . . . . . . . am/pm Finish . . . . . . . . . . am/pm
Contaminated Land
Is the ground (soil) contaminated with chemicals and/or other waste?
☐ Unlikely
register
☐ Possible
☐ Site is registered on the environmental management
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EHS-EA001
DISPOSAL
METHOD
Recycle
SOLID WASTES
Approx
quantity
per
month kg
or no.
WASTE MINIMISATION
For each of the wastes listed, indicate which
wastes, if any, are recycled either on site or
off site, treated or minimised through
equipment/process modification.
Reuse
WASTE AND POLLUTION
Tick the type and list approximate quantity and disposal
method of each waste product.
TREAT WASTES
If Yes, please indicate how
Absorbents/kitty litter
Ash – all types
Batteries
Cans/drums – all types
Empty containers
Filter Bags/Pads
Food scraps
Glass – all types
Grit – all types
Leathers
Metals-off cuts/parts
Paper/Cardboards
Plastics inc. foams
Rags
Rubbers inc. tyres
Sand/Ash/Gravel
Slag – all types
Woods inc. crates
LIQUID WASTES
TREAT WASTES
Litres
If Yes, please indicate how.
Acids
Caustics – all types
Chemicals
Contaminated
stormwater
Coolants
Degreasers
Detergents
Oils
Paints/dyes/inks
Sludges – all types
Thinners/solvents
Wash waters
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GASEOUS
EMMISSIONS
Adhesives/bonding
Carbon Monoxides
Chlorine compounds
Dust – grain etc
Dust – grinding etc
Dust – road/yards etc
Dust - wood
Fluorides
Furnace
Heavy metals/vapour
Odours
Over sprays
Ozone depleting
substances/CFCs
Resins/styrene/paints
Smoke/soot
Solvent/thinners/ink
Toxic eg oils/rubbers
NOISE SOURCES
G/m3 If
applic.
CONTROL
METHOD
TREAT WASTES
If Yes, please indicate how.
CONTROL
METHOD
TREAT WASTES
If Yes, please indicate how.
CONTROL
METHOD
TREAT WASTES
If Yes, please indicate how.
Abrasive blasting
Air & power tools
Air conditioners/fans
Animal noises
Compressors
Extracting equipment
Grinding/sawing
Hammering
Music
Other machinery
Sirens/bells/loud
speakers/phone
Vehicular
LIGHT SOURCES
Advertising
Car park
Security
Vehicular
Welding/gas-electric
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EHS-EA001
FUEL/CHEMICALS/HAZARDOUS SUBSTANCES
F & C Liquid
TANK STORAGE
U/Ground
A/Ground No. &
No. & Vol
Vol
Leaded
Unleaded
(Hi-Octane)
Unleaded
(Regular)
Diesel
Kero
Metho
Turps
Oil
(Heating)
Oil
(Lube)
Chemicals
Other
Other
Other
Hazardous
Other
Other
Gas
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DRUM/PACKAGE
60-205L
<60L
EHS-EA001
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