EMS-03-FM-0120Version 0.3 / RailCorp Environmental Management System
EPL 12208 DECC Locomotive Approval Declaration

EPL 12208 DECC Locomotive Approval Declaration Form

User Guide

THIS USER GUIDE IS NOT PART OF THE FORM AND SHOULD BE DELETEDBEFORE FINALISING THE FORM.

For further information on the roles and responsibilities associated with this form see EMS-03-WI-0019 EPL 12208 DECC Locomotive Approval.

Proponent: Name of Proponent making application to Department of Environment and Climate Change and Water (DECCW) for approval to operate locomotive under EPL 12208.

Locomotive: Class or type of locomotive to which the application applies

Application documents: A list of all documents that make up the application and that are covered by the declaration

Declaration: The Proponent must:

  • Make three declarations in respect to the application the DECCW for approval to operate locomotive under EPL 12208. The first two bullet points will apply under every declaration.
  • Select point 3 or 4, as applicable, and delete which ever of points 3 or 4 that does not apply.

If the declaration does not contain the first two points (1 and 2) and one of the last two points (3 or 4) as written in the original form then the declaration will be rejected by RailCorp and not referred on the DECCW

EPL 12208 DECC Locomotive Approval Declaration

RailCorp is the holder of Environment Protection Licence Number (EPL) 12208 that covers the scheduled activity of ‘Railway Systems’. This licence contains requirements that new classes or types of locomotives and modified locomotives are to approved by the Department of Environment and Climate Change and Water (DECCW) prior to their operation on the RailCorp managed rail network.

This declaration is in regards to the application to DECCWfor approval to operate under Section L6 of EPL 12208.RailCorp will include a copy of this form in referring an application for approval to DECC.

Proponent:
Locomotive:
Application documents attached:
On behalf of [Proponent] I declare and certify:
  1. That all information contained in the application referenced above was completed in accordance with Section L6 of Environment Protection Licence 12208 issued by the NSW Environment Protection Authority to Rail Corporation New South Wales (RailCorp)
  2. That the information provided in the application is correct and not false or misleading
(Please delete the following statement that do not apply in theapplication referenced above)
  1. That all noise limits identified Section L6.2 of Environment Protection Licence 12208 issued by the NSW Environment Protection Authority to Rail Corporation New South Wales (RailCorp) were complied with.
  2. That notall noise limits identified Section L6.2 of Environment Protection Licence 12208 issued by the NSW Environment Protection Authority to Rail Corporation New South Wales (RailCorp) werecomplied with and the application covers all of the requirements of L6.4.

Signature:
Name (Printed):
Position/Company:
Date:
Custodian: Principal Environmental Advisor (810301) /  RailCorp / Page1 of 2f2
Approver: GM Environment / Uncontrolled copy when printed / Issue Date: xx/xx/xx
Review Date: xx/xx/xx