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Smart Form

The document is a registration form for the SMART Self Monitoring and Reporting Tool, Version 2.1, intended for use by industrial plants in Pakistan. It requires detailed information about the plant, company, and contact person, as well as the type of plant and its effluent streams. Completed forms must be submitted to the Pakistan Environmental Protection Agency for processing.

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jgulzarahmed
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0% found this document useful (0 votes)
3 views2 pages

Smart Form

The document is a registration form for the SMART Self Monitoring and Reporting Tool, Version 2.1, intended for use by industrial plants in Pakistan. It requires detailed information about the plant, company, and contact person, as well as the type of plant and its effluent streams. Completed forms must be submitted to the Pakistan Environmental Protection Agency for processing.

Uploaded by

jgulzarahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SMART

SELF MONITORING AND REPORTING TOOL Plant Database Version 2.1

Pakistan Environmental Protection Agency Office Use Only

SMART Plant ID
SELF MONITORING AND REPORTING TOOL Deg. Min. Sec.

Latitude N

Plant Registration Longitude E

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

Pakistan Environmental Protection Agency 16


SMART
SELF MONITORING AND REPORTING TOOL Plant Database Version 2.1

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

Enter below total numbers in plant of:


Effluent streams_____________________ Combustion stacks ______ Process stacks________
Plant uses chromium-based chemicals for water treatment (check one)?  Yes  No
Effluent Receiving Body (check one)  Inland Waters  Sewage Treatment
 Sea
Plant Manufactures
Sulfuric Acid/Sulfonic Acid  Yes  No
Nitric Acid  Yes  No

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]

Pakistan Environmental Protection Agency

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