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Disposal at Sea Permit Application Regulations (SOR/2014-177)

Regulations are current to 2024-02-06 and last amended on 2014-09-24. Previous Versions

SCHEDULE 2(Section 3)

Environment

Canada

Environnement

Canada

Application for Permit Renewal (Disposal at Sea)*

Application Identification

(EC OFFICE USE ONLY)

Name: blank line

Number: blank line

Permits are issued in accordance with Division 3 of Part 7 of the Canadian Environmental Protection Act, 1999 (the “Act”). “Disposal” has the same meaning as in subsection 122(1) of the Act. Information provided on this form will be used to evaluate the application for a permit renewal. Information collected is intended to verify that no conditions that informed the decision to issue the original permit have changed since the original permit application.

Permit To Be Renewed

Original Permit No.

blank line

Original Permit Expiry Date

(year/month/day)

blank line

PART A — APPLICANT INFORMATION
IDENTIFICATION
1. NAME OF APPLICANT — Indicate the name that is to appear on the permit.2. TELEPHONE NO.3. FAX NO.4. EMAIL ADDRESS
5. ADDRESS6. TYPE OF BUSINESS
7. NAME OF INDIVIDUAL(S) RESPONSIBLE FOR PROPOSED ACTIVITY8. TELEPHONE NO. (if different from box 2)9. FAX NO. (if different from box 3)10. EMAIL ADDRESS (if different from box 4)
11. NAME OF TECHNICAL CONTACT(S) FOR PROPOSED ACTIVITY12. TELEPHONE NO.13. FAX NO.14. EMAIL ADDRESS
PART B — INFORMATION ON PROPOSED ACTIVITY
GENERAL INFORMATION
15. DESCRIPTION OF ACTIVITY — Describe in detail any changes to the information provided in the original permit application.
NUMBER OF PAGES ATTACHED blank line
16. TERM OF PERMIT REQUESTED ON RENEWAL (maximum one year)

fromblank lineyear/month/day

blank lineblank line

toblank lineyear/month/day

blank lineblank line

17. TOTAL QUANTITY (cubic metres or tonnes) — Indicate the maximum quantity requested for disposal under the renewed permit.
18. NEW APPROVALS — List all permits, licences and reviews, including environmental impact assessments, that are required by any federal, provincial, territorial, municipal or local agency for the carrying out of the activity described in this application and were received since the original permit application was submitted.
ISSUING AGENCYTYPE OF APPROVALID NO.DATE OF APPLICATION (year/month/day)DATE OF APPROVAL (year/month/day)
19. NOTICE OF APPLICATION — Attach evidence that a notice was published under paragraph 127(2)(d) of the Act.
CLIPPING ATTACHED □
NAME OF PUBLICATIONPLACE OF PUBLICATION (city, province)DATE OF PUBLICATION (year/month/day)
PART C — CARRIER INFORMATION (if unknown, may be provided at a later date that is prior to the start of operations)
IDENTIFICATION
20. NAME AND ADDRESS OF CARRIER21. TELEPHONE NO.22. FAX NO.23. EMAIL ADDRESS
24. NAME, TITLE AND ADDRESS OF OWNER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL25. TELEPHONE NO.26. FAX NO.27. EMAIL ADDRESS
28. NAME OF INDIVIDUALS RESPONSIBLE FOR LOADING OR DISPOSAL ON BEHALF OF APPLICANT (including the master)29. TELEPHONE NO.30. FAX NO.31. EMAIL ADDRESS
32. NAME OR NUMBER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL
If this application is to be submitted by an agent of the applicant, the applicant must complete the following authorization:
I authorize blank line (print name) to act on my behalf as my agent in the processing of this application and to furnish, on request, supplemental information in support of this application.

Date

Name (print)

Signature

This application is made for the renewal of a permit authorizing the activity described in this application. I certify that I have reviewed the information provided in the original permit application and that it is still complete and accurate with the exception of updated information provided in this application for renewal. I certify that I have reviewed the information provided in this application and that, to the best of my knowledge and belief, the information is true, complete and accurate. I further certify that I am authorized to undertake the proposed activity or am acting as the applicant’s duly authorized agent.

Date

Name (print)

Signature

Telephone No.

Fax No.

Send the completed permit renewal application, the application fee and all supporting documentation to your nearest regional Disposal at Sea Program office of Environment Canada.

 

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