Fillable Temporary Discharge Application for RURAL CITY LIVING Trade (Gore District Council New Zealand)

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Temporary Discharge Application for RURAL CITY LIVING Trade (Gore District Council New Zealand)

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Trade Waste Bylaw 2016
Application for
Temporary Discharge
Appendix C
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Fax 03 209 0357
Email info@goredc.govt.nz
www.goredc.govt.nz
Application for Temporary Discharge - Appendix C
1
Trade name and street address of trade premises
Name:
Company:
Address:
Email:
Telephone (day): Mobile:
Telephone (after hours): Fax:
Applicant responsible for liquid waste
Transportation Generation Licensed transporter
Generator/Transporter of Liquid Waste
Name:
Company:
Address:
Email:
Telephone (day): Mobile:
Telephone (after hours): Fax:
RURAL CITY LIVING
Applicant sought for
One discharge A number of discharges of the same kind of liquid waste
Proposed point of disposal
Proposed timing of disposal/s
Time: am/pm
Date:
Liquid waste
Quantity: m³
Source:
Process in which waste was produced:
General Characteristics
cBOD
5
g/ m³
COD: g/ m³
Suspended Solids: g/ m³
pH
Oil and Grease: g/ m³
Enterococci: Cfu/100ml
Application for Temporary Discharge - Appendix C 2
List any characteristics which are likely to be greater than 50% of concentrations stipulated in Schedule 1A of
the Trade Waste Bylaw:
Analysis (Check with GDC whether this is required)
Appended Not required
Declaration
We hereby certify that the above liquid waste is accurately described
Applicant:
Transporter / Generator:
Application for Temporary Discharge - Appendix C 3
Application Number:
Application:
Received by:
Date:
Discharge: Approved Not Approved
By:
Date:
Temporary Discharge
If approved:
Where discharged:
Time and date:
If not approved:
Where referred to:
Temporary Discharge Fee
Amount: $
GST: $
Total: $
Cashier Receipt:
File No:
Application for Temporary Discharge - Appendix C 4
FOR OFFICE USE ONLY
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Temporary Discharge Application for RURAL CITY LIVING Trade (Gore District Council New Zealand)

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Completed 15 November 2020

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