APPLICATION FORM FOR A PERMIT FOR DRY CLEANING ACTIVITIES UNDER THE POLLUTION PREVENTION AND CONTROL (SCOTLAND) REGULATIONS 2012 Please use this form for dry cleaning operations only. PLEASE SEND TO THE REGISTRAR AT THE APPROPRIATE SEPA OFFICE: SEPA Aberdeen Office Inverdee House Baxter Street Torry ABERDEEN AB11 9QA SEPA Dingwall Office Fodderty Way Dingwall Business Park DINGWALL IV15 9XB SEPA Angus Smith Building 6 Parklands Avenue Eurocentral Holytown NORTH LANARKSHIRE ML1 4WQ Tel: 01224 266600 Fax: 01224 896657 Tel: 01349 862021 Fax: 01349 863987 Tel: 01698 839000 Fax: 01698 738155 IED-APPL-SER-002 V2 1 SER 2: Application for Dry Cleaning Activities under the Pollution Prevention and Control (Scotland) Regulations 2012 FOR SEPA USE ONLY Date Received: Fee Received YES / NO Amount (£): Name Assigned: Application Reference: APPLICATION FOR DRY CLEANING ACTIVITIES UNDER THE POLLUTION PREVENTION AND CONTROL (SCOTLAND) REGULATIONS 2012 (“the PPC Regulations”) INTRODUCTION TO THE PPC REGULATIONS Do the PPC Regulations apply to you? Any dry cleaning installations using solvents are required to apply for a permit. Any installation being brought into operation for the first time must apply for, and be granted, a permit prior to starting operation. Purpose of this form Use this form to make an application for a permit for a dry cleaning installation under the Pollution Prevention and Control (Scotland) Regulations 2012 (PPC 2012). The information provided in this form will be used to determine your application and to set appropriate controls on your operation. It is therefore in your interests to ensure that you answer each question as fully as possible. Guidance for Dry Cleaning’, available from Her Majesty’s Stationary Office. This guidance is available in English, Greek, Urdu, Gujurati and Turkish from: http://www.defra.gov.uk/industrial-emissions/lasregulations/guidance/ Additional information Any additional documents you may want to submit as part of this application need to be identified in the application form with a document reference number. They must be clearly marked stating: Date of the application; Operator's name; Name of the installation; PPC reference number (where relevant). If you need help and advice Do not hesitate to contact the PPC Solvent Emissions Team if you need any advice on how to set out the information required. PPC 2012 transposes into Scottish legislation Council Directive 2010/75/EU (Industrial Emissions Directive (IED)) on the limitations of emissions of volatile organic compounds due to the use of organic solvents in certain activities and installations. The purpose of the IED is to reduce emissions of volatile organic compounds (VOCs) to the environment from specified industrial processes. ‘VOCs’ stand for Volatile Organic Compounds, the name given to non-methane organic compounds which evaporate easily and contribute to pollution mainly through the production of secondary pollutants such as ozone. Implementation of IED into Scottish legislation took place on 7th January 2013 with the introduction of the PPC 2012 which supercedes the Pollution Prevention and Control (Scotland) Regulations 2000. Further details on the PPC 2012 can be found at the SEPA web site: http://www.sepa.org.uk/air/process_industry_regulation/poll ution_prevention__control.aspx Before you start to fill in this form There is no separate guidance document associated with this application form. Relevant guidance for each section has been included within the Appendix to this form. Completion of the form All relevant sections of the form must be completed. Incomplete forms may result in the delay of the determination process or the application being returned to you. This form should be signed and sent as a paper copy with any other relevant forms and documents in support of your application. Guidance for applicants is provided in Process Guidance Note PG6/46(11) – ‘Secretary of State’s IED-APPL-SER-002 V2 2 SECTION A – INFORMATION ABOUT YOUR APPLICATION A1 ABOUT YOUR APPLICATION A1.1 What is the name of the installation (i.e. shop / premises where the dry cleaning takes place)? Note: the name of the premises where the activity of dry cleaning is carried out. If you already hold any permit from SEPA please use name of the installation stated in the permit. A1.2 What is the address of the site of the installation (i.e. shop / premises where the dry cleaning takes place)? Address Street Town County Postcode Ordnance Survey national grid reference for the site (2 letters then 6 numbers, for example SJ 123 567).. You can find your grid reference from your postcode at http://getamap.ordnancesurvey.co.uk/getamap/frames.htm A1.3 Please give details of any existing permit(s) for the installation (where applicable). Please give the current PPC permit number. If you do not have one, give details of any applicable IPC authorisations, APC authorisations, Groundwater Regulations authorisations, Waste Management licences or water discharge consents. A2 AUTHORISED CONTACT It will help us to have someone who we can contact directly with any questions about your application. The person you name should have authority to act on your behalf. A2.1 Who is the main contact for your application? Name: Position: Address: Postcode: Tel: E-mail: IED-APPL-SER-002 V2 3 A3 ABOUT THE OPERATOR Please provide the information requested below about the operator, which means the person who it is proposed will have control over the installation in accordance with the permit if granted. Legal status of operator A3.1 Is the operator an individual, a group of individuals, a company partnership or a company/corporate body? Individual (sole trader) or a group of individuals – go to question A3.2 Partnership – go to question A3.3 Company or corporate body – go to question A3.5 Individual applicants A3.2 Please give the following details Where more than one person is applying (other then as a partnership) we need details of each person. (Continue on separate sheets if necessary) Full name: Date of birth: Trading/business name (if any): Business address: Post code: Contact numbers: Phone number: Mobile number: Fax number: e-mail address: Now go to Question A3.7 IED-APPL-SER-002 V2 4 Application from partnerships A3.3 Who is applying? We can issue permits to named individuals and to a partnership name. However, we need details of each person in the partnership. Full name: Date of birth: Trading/business name (if any): Business address: Post code: Contact numbers: Phone number: Mobile number: Fax number: e-mail address: A3.4 Please give us the following details about the partnership Full name of partnership (if there is one): Principal place of business: Post code: Contact numbers: Phone number: Mobile number: Fax number: e-mail address: Now go to Question A3.7 IED-APPL-SER-002 V2 5 Companies or other corporate applicants A3.5 Please give us the following details Full name of the company or corporate body: Trading/business name if different: Registered office address: Postcode: Principal office address if different: Postcode: Company registration number: Date of formation of company: For applications from companies, please provide a copy of the certificate of incorporation and any certificates of subsequent name changes. Applicant Reference number for documents supplied: For applications from other corporate bodies, please provide evidence of status. Applicant Reference number for documents supplied: A3.6 Is the operator a subsidiary of a holding company within the meaning of Section 736 of the Companies Act 1985? Yes No Name of ultimate holding company: Registered office address (if different): Postcode: Company registration number: IED-APPL-SER-002 V2 6 A3.7 Is there another address you would like correspondence to be sent other than that given above? Full name: Date of birth: Trading/business name (if any): Business address: Post code: Contact numbers: Phone number: Mobile number: Fax number: e-mail address: A3.8 Billing Address Please provide details of the address you wish invoices to be sent, and details of someone we may contact about fees and charges. Name: Address: Postcode: Tel: IED-APPL-SER-002 V2 7 SECTION B – APPLICATION FOR A NEW PERMIT TO OPERATE A DRY CLEANING INSTALLATION B1 ABOUT THE INSTALLATION B1.1 Site plans & maps B1.1.1 Please provide suitable: Maps or plans showing the location of the installation; and If the dry cleaning activity is located within a larger building e.g. a supermarket a map or plan showing the location of the dry cleaning activity within the building Plan or drawing with the following: (this can be a hand-drawn sketch; it need not be to scale) 1. Where the dry cleaning machine(s) are located; 2. Dry cleaning solvent storage areas; 3. Waste residue storage areas; Applicant’s Reference number for documents supplied B1 ABOUT DRY CLEANING OPERATIONS B1.2 Use and storage of solvents B1.2.1 Please describe the location and method of storage (e.g. drums, cans, tanks, etc.) within the installation for: dry cleaning solvents (pending use); used dry cleaning solvents and wastes. Applicant’s Reference number for documents supplied B1.2.2 Please supply the solvent consumption for the installation for the last calendar year: Year on which consumption is based Total annual solvent consumption (kg or litres/ year)* (select kg/ year or l/year) * Total consumption = the total input of organic solvents into an installation per calendar year or any other 12 month period, less any VOC compounds that are recovered for reuse outside the installation. IED-APPL-SER-002 V2 8 B1.3 Dry cleaning machine specification B1.3.1 Please supply the manufacturer, model, serial number, load capacity, date of installation and type of dry cleaning solvent used for each dry cleaning machine within the installation. Manufacturer Model Serial number Rated load capacity (kg) Date of installation Dry cleaning solvent name (Continue on separate sheets if necessary) Reference number for documents supplied B1.4 Checking and maintenance of dry cleaning machine(s) B1.4.1 Please provide a list of checking and maintenance procedures for each machine, and the frequency on which they are carried out. Applicant’s Reference number for documents supplied B1.5 Other uses of solvents at the installation B1.5.1 Please provide details of any other activities carried within the dry cleaning installation which involve the use of organic solvents, in particular spot cleaning solutions, water-proofing solutions and any other solvents or solvent-borne preparations Activity Name of preparation Solvent name (Continue on separate sheets if necessary) Applicant’s Reference number for documents supplied B1.6 Staff & training B1.6.1 Please provide details on the supervision, training and relevant qualifications (or number of years experience) of staff regarding the operating and maintenance of the dry cleaning machines within the installation. Applicant’s Reference number for documents supplied IED-APPL-SER-002 V2 9 B1.7 Weighing of product B1.7.1 Please explain how the dry cleaning product is weighed and how both weekly and annual totals are calculated. Applicant’s Reference number for documents supplied B2 HAZARD STATEMENT SOLVENTS B2.1.1 Are any dry cleaning solvents or spot cleaning solvents which because of their VOC content are required to carry one or more of the following hazard statements used within the installation? H340 – may cause genetic defect H350 – may cause cancer H350i – may cause cancer by inhalation H360D – may damage the unborn child H360F – may damage fertility Yes No B2.1.2 Please identify dry cleaning solvents used, or proposed for use, that are labelled with any of these hazard statements. The individual hazard statements of each substance or preparation should be listed. Name of substance/preparation & hazard statement(s) (please supply MSDS for each substance named) Annual consumption of risk phrase substance (kg/year or litres/year) Date began or intend to begin using risk phrase substance If you use or intend using any substance with any of these hazard statements, we will contact you later to ask for further information1 1 The regulations require as far as possible and within the shortest possible time, the replacement of any substances or preparations assigned H340, H350, H350i, H360D and H360F, by less harmful substances and preparations. If you use any such substances, you will be required to submit an assessment, which details how each hazard statement substance or preparation will be replaced and within what timescale. Full justification for all findings/proposals must be provided as part of the assessment. In particular, where you consider that substitution of any such substance or preparation is not possible, a technical and economic justification should be provided. IED-APPL-SER-002 V2 10 F1 FEES & CHARGES In completing this section you can refer to the SEPA charging scheme guidance available from your local SEPA office or from www.sepa.org.uk Please note that payment of application fees may be made by cheque, BACS, credit card, debit card or by cash. Please see the charging scheme for details. N.B. If you are paying by BACS or direct transfer you MUST submit a Remittance Advice/Proof of Payment with your application form. If this is not received the application will be returned to you as invalid and a request will be made for the Remittance Advice. SEPA cannot process your application until proof of payment and the application form is received. F1.1 Application for a new permit Fill in the amount you are paying in the ‘amount column’. Please refer to the Pollution Prevention and Control (Parts A and B) Fees and Charges (Scotland) Scheme 2012 http://www.sepa.org.uk/about_us/charging_schemes/current_charging_schemes.aspx Category 1 Process/Activity Dry cleaning installation Amount(£) Please make all cheques payable to “SEPA”. F1.3 Annual subsistence If we grant you a permit, you will be required to pay an annual subsistence charge. Failure to do so will result in revocation of your permit and you will not be able to undertake dry cleaning at your installation (shop / premises). You will be sent a bill for your first subsistence payment as soon as you have received your permit. IED-APPL-SER-002 V2 11 F2 COMMERCIAL CONFIDENTIALITY & NATIONAL SECURITY F2.1 Information about your installation will be placed upon SEPA’s public register and made available to members of the public for viewing. Is there any information that you wish to justify being kept from the public register on the grounds of commercial confidentiality? Yes No Applicant’s Reference number for this information F2.2 If there is any information in the application that you believe should be kept from the public register on the grounds of national security please give: Full information on separate sheets; Provide a copy of the application form to the Scottish Ministers for a Direction (as appropriate) on the issue of national security. Note: Do NOT write anything about national security on this form, nor give reference numbers to the relevant information/documents submitted. F3 DATA PROTECTION NOTICE The information you give will be used by SEPA to process your application. It will be placed on the public register(s) and used to monitor compliance with permit conditions or to process renewal applications. We may also use and/or disclose any of the information you give us in order to: Offer/provide you with our literature/services relating to environmental matters; Consult with the public, public bodies and other organisations (e.g. Health & Safety Executive, local authorities, emergency services, Food Standards Agency); Carry out statistical analysis, research and development on environmental issues; Provide public register information to enquirers; Investigate possible breaches of environmental law and take any resulting action; Prevent breaches of environmental law; Access customer service satisfaction and improve our service. We may pass on the information to agents/representatives who we ask to do any of these things on our behalf. Individuals have a right to see the information we hold about them. We will correct it if it is inaccurate. Individuals, groups of individuals or partnerships I have read the Data Protection Notice and understand the implications of the Data Protection Act 1998. All individuals detailed on this form need to sign below. Individuals or partners signature: Name: Date: IED-APPL-SER-002 V2 12 Individuals or partners signature: Name: Date: Individuals or partners signature: Name: Date: F4 ANY OTHER INFORMATION Is there any other information you wish to submit in support of your application? Yes No (please provide reference numbers for supporting documents) Applicant’s Reference number for this information IED-APPL-SER-002 V2 13 F5 SIGNATURES AND DECLARATION It is an offence under Regulation 67 of the Pollution Prevention and Control (Scotland) Regulations 2012 (as amended) to: Make a 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. for the purposes of obtaining a permit (for yourself or anyone else) or seeking a variation or transfer of a permit. If you make a false statement: We may prepare a report to the Procurator Fiscal who may prosecute you; and If you are convicted, you may be liable to a fine or imprisonment, or both. Declaration * I/We apply for a Permit * I/we certify that the information (including supporting documentation *I/we have supplied) in this application is correct. * delete as appropriate Signature(s) of current operators Please note that each individual operator must sign the declaration themselves, even if an agent is acting on their behalf. For applications from: More than one person – all persons should sign below A company or corporate body – an authorised person should sign below and provide evidence of authority from the board of the company or body corporate. Signature: Name: Position: signature: Name: Date: signature: Name: Date: Please now return this form together with all supporting information and correct payment to the address as listed on the front cover of this form. IED-APPL-SER-002 V2 14 APPENDIX 1: GUIDANCE NOTES FOR SOLVENT EMISSIONS ACTIVITIES AP1 ABOUT YOUR ACTIVITIES The requirements of the Pollution Prevention and Control (Scotland) Regulations 2012 apply to the ‘Solvents installation’ rather than to the ‘site’. The solvents installation is defined in the Pollution Prevention and Control (Scotland) Regulations 2012, Regulation 12(1) as: “an installation where an activity listed in the table in Part 1 of Schedule 2 is operated above the solvent consumption threshold for that activity.” Directly associated activity in relation to a solvents emissions activity is defined in the Pollution Prevention and Control (Scotland) Regulations 2012, Regulation 2(1) as: “any directly associated activity which has a technical connection with the solvent emission activity carried out on the same site and which could have an effect on any discharge of volatile organic compounds into the environment”. In order to determine what constitutes the solvents installation you must therefore identify what solvent emission activity is undertaken and any relevant directly associated activities. If you carry out more than one solvent emissions activity, you must identify each solvent emission activity and its directly associated activities separately. AP2 HAZARD STATEMENTS Hazard statement substances are defined in the Pollution Prevention & Control (Scotland) Regulations 2012, Schedule 2, paragraph 12 as: ”in relation to dry cleaning, such a substance which because of the contents include a volatile organic compound is assigned or needs to carry the hazard statements H340, H350, H350i, H360D and H360F.” NOTE: You should be aware that such substances may be regulated under the Chemicals (Hazard Information and Packaging for Supply) Regulations 1994 (as amended) (“the CHIP Regulations”), which require that Material Safety Data Sheets are available for Risk phrase substances. The Material Safety Data Sheets should provide information needed to complete this section. The Control of Substances Hazardous to Health (COSHH) Regulations may also apply. AP3 VOC CONTROL METHODS VOC Controls are required for ALL Solvents Installations. There is only one VOC control method that is specified in the IED for dry cleaning activities, namely; a) Meet a total emission limit value for VOCs (e.g. solvent emissions per unit product). The relevant Technical Guidance or Process Guidance Note for your installation will detail how compliance is achieved. For dry cleaning activities, this is Process Guidance Note 6/46(11) “Secretary of State’s Guidance for Dry Cleaning” IED-APPL-SER-002 V2 15