ENVIRONMENTAL MANAGEMENT AUTHORITY

CERTIFICATE OF ENVIRONMENTAL CLEARANCE

PRE-SCREENING FORM

This Form must be completed in addition to the CEC Application Form A

1. Please state the Activity as well as the purpose of the project for which the CEC
application is being submitted (state the activity and definition categories under
which you are applying. Please refer to CEC Designated Activities Order).

List all the Activity/Activities that apply:

Definition (a) (b) (c) (d)

Purpose:

2. This Application package contains:

➢ Completed CEC Application Form A (signed and dated)

➢ Evidence of payment of prescribed Application Fee ($500.00)

➢ Where the Applicant is the property owner: Evidence of certified

copies of Proof of Ownership (e.g. deed, license/lease agreement)

➢ Where the Applicant is not the property owner: An authorisation

letter from property owner(s) supported by proof of ownership and a
copy of a valid form of Identification from the owner(s)

➢ Letter of Authorisation for agent/consultant (if applicable)

➢ Where the Applicant is a Company: CEC Application Form is signed

by the head of the organisation and stamped with the company
stamp and supported by a Certificate of Incorporation

➢ All attached documents submitted

Declaration:
I declare that the information provided on the application form and supporting
documents is true and correct. I hereby acknowledge that any wilful false
statement makes me liable to be subjected to civil proceedings for fraudulent
misrepresentation.

Signed
Applicant (PRINT NAME)

Date
Please note that pursuant to Rules 6 and 7 of the CEC Rules, the final determination of all
CEC applications remains with the Environmental Management Authority (EMA)

Revised by AO 2/4/19
 SCHEDULE

FORM A (Rule 3(1))

THE CERTIFICATE OF ENVIRONMENTAL CLEARANCE RULES 2001

APPLICATION FOR A CERTIFICATE OF ENVIRONMENTAL CLEARANCE

This form must be completed for any proposed activity identified in the Schedule of
the Certificate of Environmental Clearance (Designated Activities) Order, 2001. Essential
additional information such as plans, maps, diagrams, photographs or text may be
included in the application as an appropriately referenced attachment.

To: The Environmental Management Authority,

I/We hereby apply for a Certificate of Environmental Clearance (CEC).

Signed
Applicant (PRINT NAME)

Signed
Head of Organisation (PRINT NAME)
(Company Stamp)

Date

FOR OFFICIAL USE ONLY

Application Received……………………… Received by: ……………………………

(Date) (Signature)

Ref. No.

Acknowledgment Sent…………………………..
(Date)

Category of intended activity: (i) New (ii ) Modification

(please tick appropriate box)

(iii) Abandonment/ Decommissioning

PROJECT CLASSIFICATION

Activity Definition

Application requires CEC: Yes No Application requires EIA: Yes No

EMA: CEC 1
 CERTIFICATE OF ENVIRONMENTAL CLEARANCE

APPLICATION FORM

A. GENERAL INFORMATION

1. Name of applicant

2. Postal Address

Electronic mailing address (e-mail address)

3. Telephone No. 4. Fax No.

5. Location of proposed activity:

(a) District/Village

(b) Street (Name and Lot or LP No.)

6. Do you own the property on which the activity is intended to be carried out?
Yes No
If Yes, please attach certified copies of Proof of ownership.

If No, what is the nature of your interest in this property? Please attach supporting
documents, justifying your claim (e.g. lease).

7. Names and addresses of adjoining property owners:

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8. (a) Previous Application for CEC for this site? Yes No

(b) If yes, Reference No of most recent application

9. Activity for which CEC required (state the activity and definition categories under which you
are applying -refer to CEC Order) as well as the purpose of the project.

Activity Definition

Purpose:

10. Site Description (physical setting of the proposal, both developed and undeveloped areas)

Give an outline description of the physical features of the site to include information on:

(a) Topography and gradient i.e. generally flat rolling/undulating terrain or hilly

(b) Are there any springs or aquifers in or adjacent to the site? Yes No

(c) Are there any rivers, streams or drainage within or adjacent to the project site? Yes No

(d) Are there any ponds, reservoirs or wetland areas within or contiguous to the project site?
Yes No

(e) What is the predominant soil type? Clay based Sand Loam Alluvial

(f) Is the project located within 5km from the coast or further inland ?

(g) Present site land use: Residential Agricultural Commercial

Industrial Forestry

11. Estimated project capital (TT dollars)

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B. DESCRIPTION OF INTENDED ACTIVITY

12. Description of the Intended Activity, which must include information on:

(a) Total area intended for the activity (ha or m2)

(b) Percentage of the total surface area allocated to covered space and paved areas (%)

(c) Potable water consumption rate (m3/day)

(d) Process water consumption rate (m3/day)

(e) Project’s intended operating capacity (metric tons per annum)

(f) Production output rate, if different from above (metric tons per annum)

(g) Intended commencement date

Site Preparation and Construction Phase

13. Does the project site require major earthworks such as clearing cutting excavation
grading blasting dredging ?

If yes, state the method of disposal (and disposal site) of material generated as a result

(a) Does the site require filling reclamation coastline stabilisation/alteration ?

If yes, state the source and quantity (metric tons) of material required.

(b) Would the project require major waterworks such as abstraction diversion of water
courses creation of standing water bodies ?

If yes, give an estimate of the volume of water to be impounded (m3) or the rate of abstraction
(m3/day) and the source of this water

(c) Would the site require infrastructure and utility development:

access roads and/or bridges power generating or transmission facilities
telecommunications installation or modification of a drainage system
sewage system ?

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If yes, give details

14. Will the project require relocation of people houses facilities from the site?
If yes, give details:

15. What percentage of the intended project area would be cleared of vegetation?

16. State mitigation measures for adverse impacts resulting during site preparation and
the construction phase.

Operational Phase
17. State the required raw/input materials and the quantities/volumes (kg or metric tons/m3) to be
kept in stock for the project as well as their respective rates of consumption (kg or metric
tons per day/m3 per day).

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(a) Would the activity require any ancillary process related chemicals (e.g. catalysts, pesticides)?
Yes No
If yes, state the quantity (kg or metric tonnes/ m3) and rate of consumption.

(b) State the final products to be derived and the rate of production (metric tons/m3 per year)

(c) State any intermediate products resulting from this activity indicating the rate of production
(metric tons/m3 per year) and their fate.

(d) State the rate of production (metric tons per year) and method of disposal of domestic solid
waste generated during the operational phase.

(e) List, characterise and quantify (metric tons per year) process related solid waste. State the
method(s) and location intended for their disposal.

(f) Provide respective estimates for the rate of generation (m3per day) of domestic wastewater
and sewage. State the respective treatment methods intended for domestic wastewater and
sewage as well as their ultimate effluent points.

(g) State the source and process water consumption rate (m3 per day)

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(h) Would the activity discharge process related liquid effluent? Yes No

If yes, state the source, composition, discharge rate (m3 per day) and the ultimate effluent points.

(i) Would this activity utilise any hazardous (i.e. toxic, flammable, explosive, radioactive etc.)
substances? Yes No

If yes, provide a listing of the substances and the quantities to be used or stored.

18. Would the project require storage of input and/or waste material on site? Yes No
If yes, give estimates of the quantities (kg or metric tons) for the storage of:

Waste Input material

(a) Describe briefly the facilities allocated for this purpose

19. Indicate the mode(s) of transport intended for materials and equipment necessary
for the operational phase.

20. Will the activity generate air emissions (i.e. particulate emissions such as dust or pollutant
gaseous emissions) during the operational phases? Yes No

If yes, describe types and sources and provide an estimated emission rate or loading

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21. Will the activity routinely produce odours (i.e. for more than 1 hour per day)? Yes No

22. Will the activity generate significant levels of noise (i.e. for more than 1 hour per day at
levels exceeding 60 dB) during its operational phase? Yes No

23. Will the project have adverse effects on the aesthetics of the area where it is located (i.e.
result in radical changes of the landscape, such as scarring/mass vegetation removal)?
Yes No

24. State mitigation measures for adverse impacts resulting during the operational phase.

25. State the expected lifespan of this activity

C. CONFIDENTIALITY

26. (a) Do you consider any information provided here to be a trade secret or other
confidential business information and that such information be omitted from the Register?

Yes No

(b) Give details

27. Other relevant information

28. Please list any attachments included in the application