Smart Form
Smart Form
SMART Plant ID
SELF MONITORING AND REPORTING TOOL Deg. Min. Sec.
Latitude N
Please fill in this registration form if you wish to receive additional copies of the SMART software for
use in other sections of your plant or at other plants owned by your company.
Software Requirement
Please select your preferred medium for receipt of software (check one). CD-ROM Diskettes
User Information
Are you already using SMART at an existing plant or subunit (check one)? Yes No
If Yes, please enter SMART Plant ID codes for existing units below:
Plant ID Plant Name District Province
___________ ________________________ _______________________ ________________
___________ ________________________ _______________________ ________________
___________ ________________________ _______________________ ________________
Enter information below for new plant to be registered, using a separate form for each new plant or
unit. Please follow instructions in small print under each blank, and write legibly in ink.
Company
Company Name____________________________________________________________________
Name of company, corporate entity, or holding concern owning and operating plant (not description of plant, e.g., Rerolling Mills)
Address __________________________________________________________________________
Street address in Pakistan of head office of company named above (not address of plant, if different)
City_______________________________________________ Post Code______________________
City in which company office is located 5-digit postal code of office location
Chief Executive ____________________________________________________________________
Name of company’s chief executive officer in Pakistan
Designation _______________________________________________________________________
Company designation of CEO (e.g., Managing Director, Chairman, etc.)
City Code ______________ Tel. ________________________ Fax ___________________________
NWD code for head office Telephone number(s) of head office Fax number(s) of head office
Email ____________________________________________________________________________
Email address for company or CEO
Plant
Plant Name _______________________________________________________________________
Name of industrial plant for which data is to be monitored and reported
Address __________________________________________________________________________
Street or mailing address of plant named above (PO box or milestone addresses acceptable)
City_______________________________________________ District_________________________
City, town or village in which plant is located District in which plant is located
Contact Person ____________________________________________________________________
Person at plant responsible for monitoring and reporting EPA data
Designation _______________________________________________________________________
Company designation of person named above
City Code ______________ Tel. ________________________ Fax ___________________________
NWD code for plant Telephone number(s) of plant Fax number(s) of plant
Email ____________________________________________________________________________
Email address for plant or contact person
Type
Plant Type (check only one).
Brick Kilns (Firewood, Bagasse and Coal) Petrochemical
Cement Petroleum Refining
Chloralkali (Mercury and Diaphragm Cell) Pharmaceutical Formulation
Chloralkali (Diaphragm Cell) Phosphatic Fertilizers
Chloralkali (Mercury Cell) Photographic Processing
Dairy Pigments and Dyes
Detergents Plastic Materials and Products
Fruit and Vegetable Processing Printing
Glass Manufacturing Pulp and Paper
Glue Manufacturing Rubber Products
Industrial Chemicals Sugar
Iron and Steel Synthetic Fibers
Marble Crushing Tanning and Leather Finishing
Metal Finishing and Electroplating Textiles
Nitrogenous Fertilizers Textile Processing
Oil and Gas Exploration Thermal Power Plants (Coal- and Oil-Fired)
Oil and Gas Production Thermal Power Plants (Gas-Fired)
Others Vegetable Oil and Ghee Mills
Paints, Varnishes & Lacquers Wood and Cork Products
Pesticides Woolen Mills
Pesticide Formulation
Verification
Please verify that the information provided above is correct, sign the form below and send it to the
Pakistan Environmental Protection Agency. Incomplete forms will not be accepted.
__________________________________________________ ______________________________
Signed Date
Mail or fax to:
Pakistan Environmental Protection Agency (Pak EPA)
House 311, Margalla Road, F-11/3
Islamabad 44000
Tel: (051) 9235142
Fax: (051) 9267622
Email: [email protected]