The Environmental Permitting (England and Wales) Regulations 2016
SR2010No11 Mobile plant for treatment of waste to produce soil, soil substitutes and aggregates
Deployment Form MPD1
Please read the guidance notes for MPD1 before filling in this form. This form may only be used for deployments to treat soil, soil substitutes and aggregates where the operator holds a standard permit referring to Standard Rules SR2010No11.
Section A Your organisation
A1 Contact details
A1.1 Your customer number (if applicable)
Customer numberA1.2 Contact details for this deployment
(the person we can speak to about the details supplied with this form)
NameOrganisation
Position
Address 1
Address 2
Address 3
Post code
Phone number(s) / Office:
Mobile:
A1.3 What is your preferred method of correspondence? (please tick one)
post
A2 Your permit details
A2.1 Permit under which this deployment is taking place
Permit numberA2.2 Nominated competent person
(the person who will be responsible for compliance with the permit for this deployment - see guidance for further details)
NameOrganisation
Position
Address 1
Address 2
Address 3
Post code
Phone number(s) / Office:
Mobile:
Section B Deployment details
B1 Risk assessment
B1.1 Is the site within 500m of a European Site, Ramsar or Site of Special Scientific Interest (SSSI)?
Yes – your site specific risk assessment must include how you will ensure your activities do not impact on these sites.
No – I am using the generic risk assessment for SR2010No11
B1.2 Is the site within a groundwater source protection zone (SPZ) 1 or 2?
Yes – go to B1.3
No – I am using the generic risk assessment for SR2010No11 (now go to B2)
B1.3 Do you intend to store and treat wastes from table 2.2 of the Rules?
Yes – go to B1.4
No – go to B2
B1.4 Do you intend to store and treat these wastes on an impermeable surface?
Yes
No – you must submit a site specific risk assessment that demonstrates that the risk to groundwater can be controlled using alternative measures.
B2 About the land where the waste operation will be carried out
B2.1 General address
Address 1Address 2
Address 3
Post Code
12-Figure Grid
Reference / e.g. AB 12345,12345
B2.2 You must provide a location map outlining the area of land where the treatment will take place. (You must include the details listed in the guidance).
Location map in accordance with guidance attached.
B3 Occupancy details
B3.1 Are you the occupier of the land?
Yes - please go to B4
No - Please give the details of the land owner or main occupier (e.g. tenant)
NameOrganisation
Position
Address 1
Address 2
Address 3
Post code
Phone number(s) / Office:
Mobile:
B3.2 Do you have the occupants consent to carry out the activity?
Yes - Please go to section B5
No - Please give details below why you can carry out this operation without the consent of the occupier.
B4 – Checklist of supporting documents
If you don’t provide us with all the information we need, we won’t be able to assess your proposal and the deployment may be rejected.
Please tick and complete as appropriate, enter N/A if not applicable
Map
Location map (required for all deployments)
Document reference number(s)
Risk assessment
Site specific risk assessment (required for all deployments within 500 metres of a European Site, Ramsar or SSSI or within a SPZ 1 or 2.
Document reference number(s)
SR2010No11 Generic risk assessment used
Fee (please see published annual charging scheme and guidance for fee)
Fee enclosed (full fee required at first deployment)
No fee (already paid)
SECTION C – Declaration
Please read through the following information before ticking the box in the declaration section below
The information provided will be processed by Natural Resources Wales to deal with your notification, to monitor compliance with the permit conditions, and for maintaining the relevant public register(s).
We may also process and/or disclose it in connection with the following:
- offering/providing you with our literature/services relating to environmental matters.
- consulting with the public, public bodies and other organisations (e.g. Health and Safety Executive, local authorities, emergency services, DEFRA on environmental issues).
- carrying out statistical analysis, research and development on environmental issues.
- providing public register information to enquirers.
- investigating possible breaches of environmental law and taking any resulting action.
- preventing breaches of environmental law.
- assessing customer service satisfaction and improving our service.
- responding to requests for information under the Freedom of Information Act 2000 and the Environmental Information Regulations 2004, where the Data Protection Act allows.
Individuals have a right to see the information we hold about them. We will correct it if it is inaccurate.
We may pass it on to our agents/representatives to do these things on our behalf.
You should ensure that any persons named on this form are informed of the contents of this data protection notice.
Disclosing information you provide to us in this notification
We will place some of the information from your notification on the public register
- your name;
- where the activity is taking place; and
- details of the activity.
Declaration
The notification contact must tick the declaration section. The notification contact must be the operator or their agent.
A person knowingly or recklessly making a statement which is false or misleading in order to obtain a registration (for himself or another person) commits an offence under regulation 38 of the Environmental Permitting (England and Wales) Regulations 2016.
If you make a false or misleading statement –
- we may prosecute you; and
- if you are convicted, you are liable to a fine or imprisonment (or both).
/ I declare that the information provided both on the form and in the supporting documentation which has been supplied with this form is correct.Deployment form MDP1- version 3, January 2017 Page 1 of 5