Private Bag 9023 | Whangarei 0148 | New Zealand
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12/58293 August 2012
Application under the Trade Waste Bylaw of Whangarei District Council
dentistry format
Office use
Date received
File no
Consent no
Issuing officer
Details of business (trade waste producer)
Name of business:
Street address:
Postal address:
Phone no:
Nature of activity generating trade waste:
Name and address of applicant (if different from above)
Name:
Address:
Phone no:
Details of trade waste discharge
Type of application
Proposed discharge
Existing discharge with no consent
Consent renewal
Consent number
Variation of existing discharge
Type of variation
12/58293 August 2012 2
Volume and rate of discharge
Average daily volume (m
3
)
Maximum flow rate (L/sec)
Daily/seasonal variation (if any)
Proposed method of flow measurement:
Calibrated meter (e.g. mains/internal supply) Manufacturer specification Other (please specify)
Composition of discharge
Is there a pre-treatment system (e.g. filter or similar) Yes No
If yes, please specify
Any other chemicals on site
Drainage layout
Diameter of sewer being discharged into
Attach plan/sketch of the drainage layout for premises. Include details of:
i Any pre-treatment systems and management plans for their operation
ii Reservoirs or impounding areas to which wastes could be diverted in an emergency
Additional information:
Please include any supporting information you may have, i.e. material safety data sheets for chemicals,
existing resource consents, relevant management plans, etc
Compliance statement (to be completed by executive representative of registered company)
The discharge referred to in this application complies with all conditions of the Trade Waste Bylaw 2012.
The discharge does not contain any substances which are specifically prohibited under Schedule 1B of
the Trade Waste Bylaw 2012. I understand that under Section 4.10 of this bylaw, failure to limit trade
waste discharges to within the parameters specified in Whangarei District Council’s Trade Waste Consent
or Special Agreement issued under this bylaw can be reasonable grounds for cancellation of this consent.
Signature
Name (please print)
Designation (please print)
Business name (please print)
Date:
Application checklist
All sections completed
Yes No
Analysis attached
Yes No
Drainage plan/sketch attached
Yes No
Application signed
Yes No
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