Environmental Health Services SPEED MEMO To: . - , .-L, ,I Your Ref: 7 - - From: <-.I-.,, L ,\ d I /+'- L '( Lb. \ I L:<d j ~ X c t d i a l : !---JLi RE: -. - . (2 Our Ref: /. 7 ,"17~L,1 ;-$ Date: ,kc<:g, , \- WHITE TO RECIPIENT. GREEN FELE COPY. YELLOW OFFICER COPY - .- / I , ;- -:3 -, APPLICATION FORM (DRY CLEANERS) LOCAL AUTHORITY POLLUTION PREVENTION AND CONTROL L. ,-' Ilciga l~ .- ( i dv K. lianslead I ~ O I ; ~ II!~ I, ~OIl l N ~ , i ! Banstel@ 1 Harley I Redhill 1 Reigare POLLUTION PREVENTION AND CONTROL ACT 1999 - ! = = POLLUTION PREVENTION AND CONTROL (ENGLAND AND WALES) REGULATIONS 2000 (AS AMENDED) This is the application f o m for a permit to operate a dry cleaning installation (dry cleaners), as defined in Schedule 7 of The Solvent Emissions (England and Wales) Regulations, 2004 SI 107. #-' Before filling in this form please read the DEFRA guidance. There are a number of other documents you may need to send us with your application. Each time a request for a document is made in the application form, you will need to record a reference number for the document or documents you are submitting in the space provided on the form for this purpose. Please also mark the docurnent(s} clearly with this reference number. Please send the ORIGINAL and ONE COPY of this form and all other documentation to assist in the processing of your application. We have made the application form as straightfonvard as possible, but id you need to contact us you can do so in the following ways: IN WRITING: The Environmental Protection Team Envimnrnental Health Services Reigate and 8anstead Borough Council Town Hall Castlefield Road Reiga te Surrey RH2 OSH BY TELEPHONE: 01737 2764000 WEBSITE: w\rvw.reigate-banstead.gov.~k/publi~JEn~ir~nment/EHlEP f- The application documents must be accompanied by a cheque for £134, the correct application fee for the year 200612007. The completed application form and application fee will need to be submitted to the Council at the above address. We recommend that you do sa either by hand and obtain a receipt, or by post using special delivery. 1. OPERATOR DETAILS 1.1 Name of the dry cleaners I-2 Please give the address of the dry -50e12;?6 Dpv ~ ~ Ceeu~k% cleaners 76 STOM or24 ab 8~3-173 3 Telephone number of the dry cleaners: ..................................................................... Email Address: (this is not compulsory, but will help us to get information to you quickly) h Ordnance Survey national grid reference 8 characters; T~Z~-Y,% (for example SJ123 456, there are a number of internet mapping sites which will conveti a Post Code to a grid reference) P 1.3 Existing authorisations or permits Do you have an existing authorisalion or permit for the dry cleaners? ......................................................................................................................... ......................................................................................................................... 7.4 The Operator (The person who it is proposed will have control over the, dry cleaners, in accordance with the permit (if granted)) Please provide the full name of the company or corporate body or the name of the sole trader or the name of the partners. .......*............................ ................*.... S u e ~..... ~ . . . . . . . d .G..~P~...C Tradinglbusiness name (if different) P Registered Office address (or for sole traders and partnerships, your usual address for '3 23173 0lZ73 Telephone number of the Registered Office ............................................................... Company registration number I.5 .............................................................................. Holding Companies Is the operator a subsidiary of a holding company within the meaning of Section 736 of the Companies Act 1985. n' NO? YES? (Name of ultimate holding company) ......................................................................................................................... M : \ E N V H E A L T . H \ E P \ E N V - P R O T \ W O ~ ~ \ Cleanerstweb ~ ~ ~ ~ ~ ~ ~Site ~ Info\Dry ~ ~ P ~Cleaner ~ ~ ~ Psrmlt ~ ~ ~ Application ~ R ~ ~ ~ ~ ~2~ ~ ~ ~ Form (July 2006)FINALdm Ultimate holding company Registered Ofice address Telephone number: ................................. ............................ ..... Company h gist ration number: 1.6 ......................................... Who can we contact about your application? It will help us to have someone who we can contact directly with any questions about your application. The person you name should have the authority to act on behalf of the operator of the dry cleaners. This could be an agent or consultant, if you have appointed one, rather than the operator B-~-rc- ~ w.....-........*..................... ?.~ ... Name .................................. Position ..................................................................................................... \-C?~P ~ u 2 7 ~ 3 R Address .... ....................................... ......................................................... .................................................. Telephone "urn ber ~ ( 4 .s.B.2? 3 Fax number ..................................... O!z? 3. Email Address: (this is not compulsory, but will help us to get information to you quickly) 2. ABOUT THE DRY CLEANERS 2.1 Please provide a plan, showing the location bf the dry cleaners. Document Reference ..... .&. 2.2 M A.!G.-.~'! P (3.e.w.~. ........aO.!. A plan of sufficient scale to show the internal layout of the dry cleaners, with the following clearly marked: (a) where the dry cleaning machines will belare installed (b) where the dry cleaning solvents will belare stored (c) where the dry cleaning residue will belare stored Document Reference 2.3 ... -1.!.G.-. O.O.!...e.. ........................................................ A plan showing the location and run of any drains within the dry cleaners and in the immediate area of the dry cleaners, which may be affected as a result of any potential Volatile Organic Compound (VOC) release from the dry cleaning operations Document Reference 1 1 a - I s C s \ G + ............................................................................................. M : \ E N V H E A L T . H \ E P \ E W - P R O ~ W ~ ~ ~ ~ m ~ a l ~ P o l l ~ i o n ~ R eCleaners\Web g ~ l a t l o n \ DSlte ~ hfo\Dry Cleaner Permit Application Form (July 2006) FIMAP.doc 3 3, DRY CLEANING MATERIALS STORAGE AND EQUIPMENT The following information is required to enable us to determine whether you will operate the dry cleaners in such a way so as to ensure that all environmental requirements of the Pollution Prevention and Control (PPC) Regulations are met. 3.1 Provide a descriptipn of the location and methods of storage of: {a) dry cleaning solvents (b) dry cleaning residue \\O Document Reference ......................... o lA .... o.............................................................. 3.2 Provide details of the make, model, namelnum'ber, serial number, load capacity, date of installation and type of dry cleaning solvent used. 3.3 Provide details, including a schedule of checking and maintenance procedures for each dry cleaning machine. This should include the machine manufacturers' recommended operating procedures, checking and maintenance requirements and any other additional procedures undertaken by the operator. See attached sheet headed "Guidance for Routine Maintenance". Document Reference 3.4 t- 005 s L ~ Q P ! ~ ~ ............................................................................................. Provide details of any other activities carried out within the dry cleaners which involve the use of organic solvents, in particular spot clean solutions, water proofing solutions and any other solvents or solvent borne preparations. SUPR&C -LC 0 ~ 3tF 7e-s~ S U ~ P L ~ G ~ Document Reference ............................................................................................ - 3.5 Provide details on the training and relevant qualifications regarding operating and maintaining the dry cleaning machine in accordance with relevant guidance (see Process Guidance Note 6/46 - Secretary of State's Guidance for Dry Cleaning) Document Reference 3.6 50 P C ....................... . ................................................................. Specify how the product will be weighed and recorded both weekly and annually. Supa&, oc- /kc. ca 3 PEWE Document Reference ........................ .......................................................... .... 3.7 Provide details on how the mass or volume'of solvent will be determined and recorded both weekly and annually, (With regard to spot cleaning, the amount of solvent used wilj only need to be determined annualEy, because the amount used is so lowm) Document Reference oo soeU-c~ 3 ................... .................................................................... M:\ENVHEALT.H\EP\ENV-PROnWork\lndusMal_ Form (July 2006)FINAL.doc ..7n.. Cleaners\Web Site Info\Drj Cfeaner Permit Application 4 Risk Phrase Solvents Are any substances or preparations which because of their VOC content are required to carry one or more of the following risk phrases used within the dry cleaners: R45 - May cause cancer R46 - May cause heritable genetic damage R49 - May cause cancer by inhalation R60 - May impair fertility R61 - May cause harm to the unborn child El Yes (Details of the risk phrases of the materials used can be found on the otiginal suppliers packaging and in the Materials Safety Dafa Sheet (MSDS) fw the product). If your answer to 3.8 is Yes, please provide details of how and why these risk phrase materials are used and how the requirements of the amendment 1C of Schedule 1 of The Solvent Emissions (England and Wales) Regulations, 2004 SI 107, substitution, control and limiting of emjssions of risk phrase malerials will be met. Document Reference ............................................................................................. ADDITIONAL INFORMATION Please supply any additional information you would like us to take account of in considering this application Document Reference ............................................................................................. APPLICATION FEE Please state the amount enclosed as an application fee for this installation Cheques shoujd be made payable to Reigate and Banstead Borough Council We will confirm receipt of the application fee when we write to you aaknnowledging your application. Your application cannot be processed unless the application fee is enclosed, Please give any company purchase order number or other reference you wish to be used in relation to this fee. ANNUAL CHARGES If we grant you a permit, you will be required to pay an annual subsistence charge. 'Failure to pay this charge will result in the revocation of your permit and you will not be able to operate the Dry Cleaners M : \ E N V H E A L T . H \ E P \ E N V - P R O ~ W o r k \ l n d u sCleaners\Web t~ Site tnfo\Drj Cleaner Permlt Application Form (July 2006)FINAL.doc - C J 6.1 Please provide details of the address you wish invoices to be sent to, and details of someone we may contact about fees and charqes. Name: ~ R Y R- N~ O D t G T O ~ ..........................,.....a. ................................... €7014 .. .................................... p R 0 ~ R . r ......................................................... Pos~tron: ab H - o R ~ L ~ 16 ~ ~ G H T - O N .). ............................ Address: ....................................................... 9... 01-3- e37-73 ...................................................... ... ................. Email address: (this is not campullsory, but will help us to get information to you quickly) Telephone number: 7. COMMERCIAL CONFIDENTIALITY 7.1 Is there any information in the application that you wish to justify being kept from the public register on the grounds of commercial confidentiality? Yes Please provide full justification, considering the definition of commercial confidentiality within the PPC Regulations. Document Reference 8. ............................................................................................. DATA PROTECTION The information you give will be used by this authority to process your application. It will be placed an the relevant public register and used to monitor compliance with the permit conditions. We may also use and or disclose any of the information you provide in order to: m * * * consult with the public, public bodies and other organisations, carry out statistical analysis, research and development of environmental issues, provide public register information to enquirers, investigate possible breaches of environmental law and take any resulting action, prevent breaches of environmental law, assess customer satisfaction and improve our service. Information that does not need to be on the public register may be released under the Environmental Information Regulations 2004. We may pass on the information to agentstrepresentatives who we ask to do any of these things on our behalf. It is an offence under Regulation 32 of the PPC Regulations, for the purpose of obtaining a permit (for you or anyone else) to: make a false statement which you know to be false or misleading in a material particular, recklessly make a statement which is false or misleading in a material particular. If you do make a false statement we may prosecute you, and if you are convicted, you are liable to a fine or imprisonment (or both). M : \ E N V H E A L T . H \ E P \ E W - P R O ~ W O ~ ~ \ ~ ~ ~ U S ~ ~ ~ ~ P ICleanws\Web ) I I U ~ ~ O ~ ~Slte R ~Info\Dry ~ U I ~ HCleaner ~ ~ \ D Permit ~~ Application Fom (July 2006) FINAL.doc 6 DECLARATION 9.1 Signature of current operator(s)* I-certify that the information in this application is correct. FlWe apply for a permit in respect of the particulars described in this application (including supporting documentation) Ilwe have supplied. please note that each individual operator must sign the declaration themselves, even if an agent is acting on their behalf. For the application from: Installationname .... sup^&& 3% ~ W N L ~ S ..................... Signature F- Name BQV t.A rJ ......*.,. H .... I ~0erad/ ................................................ Position Date ,=- Signature ......................................................................................... Name .......................................................................................... Position .......................................................................................... Date .......................................................................................... * Where more than one person is defined as the operator, all should sign. Mere a company or other body corporate, an authorised person should sign and provide evidence of authority from the board of the company or body corporate. FOR LOCAL AUTHORIW USE ........................................ s ~ ~ ~ ~ Date' received P A................................. la O~ L ~ a ~ x. ~ %V Officer Reference ................................. Installation Reference M:\ENWEALT.H\EP\ENV-PROT\Work\lnd~~trial~P011ution~Reg111at'~)n\D~ Cleanerweb Site Info\Dry Cleaner Pennit Application Form (July 2006) FINAL.doc 7 APPLICANT'S SUBMISSION SEPARATOR SHEET Paragraph Reference....................... -2.2.. ........ Document Reference ........ - 13 0-001A.. .. me following are labelled on the plan: A ..........Dry cleaning Machine I3.......Perchlorethylene storage C.. ............ Storage of residues D.. ... Drain runs (not affected ) APPLICANT" SSTS-BMISSIONSEPARATOR SHEET P m g r a ~ hReference...... ...2.1. .............. ... ... .... Document Reference ... ...OJS Map showing location of : Supreme Dry Cleaners 76 Brighton Rd., Horley, Surrey RH6 754 Siteplan" I : I 250 ~rcduced07 Aug 2[XW from ORlnawa Survey dgital data and inowporating surveyed revlston ava~lablaatthis date. @ ~ m w CnM06. Rvroduction in A d e or h pan is fmhibifed mthout the plkr permksm of Ordnance Survw Ordnance Survsy ard Itw aS symbol are r s g i n d trade maris &Snepbn a aade markof Ordnance S u w n ho mapping wv of Grmt Bmam. Manbna1 Grid shaet d e m at cmtm d this Sitephn: T02843NW by The BMdiding Centre S a d Number. MX)57800 mPLICA_NT'S SUBMlSSlON SEPARATOR S E E T Paragraph Reference.........3.4. .. ... ............... ... . Document Reference ...... Supreme 004 Data Sheets for all spottingl proofmg chemicals, and Perc, are enclosed. Perchlorethylene Ammonia solution Ready Strip Tam1 I? 01 Colour Rostol Tintol Devantol Super Secapur Dry Master Devantol Soft These are entered on the appropriate sheet when new and added to any still in stock. The use o f the spotting chemicals is totalled annually I Ist~&06107 Volume Replaced / I Spotting 1 Proofing Chemicals - - -- . Volume-in- stock-. Ammonia-Soln. -Ready Strip Tanol - I BFotoF Colour ,~ o s -Tintol Devantol Super Secapur-Dry - - Master Devantol soft - o l 1 - - 4-I - I I 1 I I I ! I I I I I 1 1Write in when new 1 1 t I .- .-I ! . Yearly VolumeUsed --- -- I I -- TexUk Cars .Supplies Ud +- SAFETY DATA SHEET Textile Care Supplies Ltd 32134 Whitehill Road . Whitehill Ind. Estate PRODUCT NAME: SVPPLER: , GIenrothes Fife KY6 2RW C INGREDfENl' NAME TETIUCflLOKOETIlYLEh'E: CAS NO: CObIPOSITION C O M m S : .t CASNo. 127-1 8.4 127-18.4 (c~s) EUSK (R NO,) Xu, 40 COhTENfS HEALTIE 60-100% ElKECS NUMBER: 205-500-4 1 > Prisk QI Po$$ibl~ Irrevcrsfblt etkeu. Cureinogcn Categor). 3. NOTE TO PHYSICJAN t Because mpid abrorpiion may, occur through lungs if upinred and enuse iysrcmalic eff+u. I h e decision of whe~herto induce vornirfng:or not should be made '!b an attending physician. If lavage 1s ped9,t&d,,:''' ' suggwt cndolnchta1 andlot oesophagca! con(ml.1:~ D a n ~ i r from lung spiralion must b t weighed against toxiFtly;;phta mnsidcn'ng empl~ingthe stomach. If burn is presenl,'l&z as my thermal burn. afrer decbnlamination. Exposvrc may increase myocardial Im'rabltiry. Do not give s~mpn~harnimetlc drugs unless sbsoludy nemssorv, No specific antidote. Supponive care. Treatmen&based on judgcmcnt of physician in response to reaclions of the paricnt. Page I >>>