Disposal at Sea Permit Application Regulations

Link to law: http://laws-lois.justice.gc.ca/eng/regulations/SOR-2014-177/FullText.html

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Disposal at Sea Permit Application Regulations

SOR/2014-177CANADIAN ENVIRONMENTAL PROTECTION ACT, 1999
Registration 2014-07-09
Disposal at Sea Permit Application RegulationsWhereas, pursuant to subsection 332(1)Footnote a of the Canadian Environmental Protection Act, 1999Footnote b, the Minister of the Environment published in the Canada Gazette, Part I, on December 14, 2013, a copy of the proposed Disposal at Sea Permit Application Regulations, and persons were given an opportunity to file comments with respect to the proposed Regulations or to file a notice of objection requesting that a board of review be established and stating the reasons for the objection;
Therefore, the Minister of the Environment, pursuant to subsection 135(3)Footnote c of the Canadian Environmental Protection Act, 1999Footnote b, makes the annexed Disposal at Sea Permit Application Regulations.
Gatineau, July 7, 2014
LEONA AGLUKKAQ
Minister of the Environment

Return to footnote aS.C. 2004, c. 15, s. 31
Return to footnote bS.C. 1999, c. 33
Return to footnote cS.C. 2012, c. 19, s. 161(4)
Interpretation

Definition of Act
1 In these Regulations, Act means the Canadian Environmental Protection Act, 1999.

Applications

Permits

Marginal note:Permit application

2 An application for a permit referred to in subsection 127(1) or 128(2) of the Act must be submitted in the form set out in Schedule 1 and must contain the information relevant to the application that is provided for in that Schedule.

Renewal of Permits

Marginal note:Renewal application

3 An application for a renewal of a permit referred to in subsection 127(1) of the Act must be submitted in the form set out in Schedule 2 and must contain the information relevant to the application that is provided for in that Schedule.

Repeal

4 [Repeal]

Coming into Force

Marginal note:S.C. 2012, c. 19

*5 These Regulations come into force on the day on which subsection 161(3) of the Jobs, Growth and Long-term Prosperity Act, chapter 19 of the Statutes of Canada, 2012, comes into force, but if they are registered after that day, they come into force on the day on which they are registered.
Return to footnote *[Note: Regulations in force September 24, 2014, see SI/2014-6.]

SCHEDULE 1(Section 2)

Environment
Canada

Environnement
Canada

Permit Application (Disposal at Sea)*

Return to footnote *Ce formulaire est disponible en français.

Application Identification
(EC OFFICE USE ONLY)
Name:
Number:

Permits are issued in accordance with Division 3 of Part 7 of the Canadian Environmental Protection Act, 1999 (the “Act”). “Disposal” has the same meaning as in subsection 122(1) of the Act. Information provided on this form will be used to evaluate the application for a permit.
Applicants should consult their nearest regional Disposal at Sea Program office of Environment Canada before preparing or submitting an emergency permit application under section 128 of the Act.
The following activities are covered by this application. Indicate those activities that apply to you:

□ 1. Loading for the purpose of disposal
□ 2. Disposal of waste or other matter

□ 3. Disposal on ice
□ 4. Other:

Substance To Be Disposed of at Sea

PART A — APPLICANT INFORMATION

IDENTIFICATION

1. NAME OF APPLICANT — Indicate the name that is to appear on the permit.
2. TELEPHONE NO.
3. FAX NO.
4. EMAIL ADDRESS

5. ADDRESS
6. TYPE OF BUSINESS

7. PERMIT HISTORY — List the permit numbers and expiry dates of any previous permits, including renewals, that are relevant to this application.
Permit No.

Expiry Date (year/month)

8. NAME OF INDIVIDUAL(S) RESPONSIBLE FOR PROPOSED ACTIVITY

9. TELEPHONE NO. (if different from box 2)

10. FAX NO. (if different from box 3)

11. EMAIL ADDRESS (if different from box 4)

12. NAME OF TECHNICAL CONTACT(S) FOR PROPOSED ACTIVITY
13. TELEPHONE NO.
14. FAX NO.
15. EMAIL ADDRESS

PART B — INFORMATION ON PROPOSED ACTIVITY

GENERAL INFORMATION

16. DESCRIPTION OF ACTIVITY — Give a general description of the proposed activity and its purpose.
NUMBER OF PAGES ATTACHED

17. SUBSTANCE TO BE DISPOSED OF AT SEA — Indicate the substance to be disposed of at sea. See the portion of Part 1 of Appendix 1 that pertains to the substance you wish to dispose of for further details regarding the information that must be included in your application. In the case of incineration, see Part 2 of Appendix 1.
NUMBER OF PAGES ATTACHED

18. TERM OF PERMIT REQUESTED (maximum one year)fromyear/month/day

toyear/month/day

19. TOTAL QUANTITY (cubic metres or tonnes) — Indicate the maximum quantity requested for disposal under the permit. For dredged material, the quantity must be calculated in cubic metres using place measurement.

20. DO YOU WANT THE REQUESTED PERMIT TO BE CONSIDERED FOR RENEWAL? — If yes, complete boxes 21 and 22. If no, proceed to box 23.Yes □No □

21. RENEWAL QUANTITY (cubic metres or tonnes) — Estimate the maximum quantity for disposal under each expected renewal. For dredged material, the quantity must be calculated in cubic metres using place measurement.First Renewal
Second Renewal
Third Renewal
Fourth Renewal

22. NUMBER OF POTENTIAL RENEWALS REQUIRED — Indicate how many times renewal may be required (maximum four renewals).

23. LOAD SITE(S) — For dredged or inert, inorganic geological material, provide a detailed drawing showing the boundaries of each site to be dredged or excavated.

NAME AND ADDRESS OF SITE(S) (if any)

LATITUDE (decimal degrees to five decimal places, referencing NAD83)

LONGITUDE (decimal degrees to five decimal places, referencing NAD83)

QUANTITY TO BE LOADED (cubic metres or tonnes)

NUMBER OF PAGES ATTACHED

24. DISPOSAL SITE(S) — Provide a detailed drawing showing the boundaries of each disposal site or release zone (unless your nearest regional Disposal at Sea Program office has indicated otherwise).

DISPOSAL SITE NAME (if any)

LATITUDE (decimal degrees to five decimal places, referencing NAD83)

LONGITUDE (decimal degrees to five decimal places, referencing NAD83)

DEPTH (metres)

QUANTITY TO BE DISPOSED OF (cubic metres or tonnes)

Provide an estimate of the movement and dispersion in the water column and on the sea floor of the substance disposed of at sea. In the case of disposal of dredged material or inert, inorganic geological matter at a new disposal site, or disposal of any substance on ice, see the relevant portion of Appendix 2 for further details regarding the information that must be included in your application.
NUMBER OF PAGES ATTACHED

25. ROUTE FROM LOAD SITE TO DISPOSAL SITE — Attach a map, chart or good reproducible set of drawings that shows the location of each load site and each disposal site. If the route is not direct, explain why and show the intended route on the map, chart or drawings.
NUMBER OF PAGES ATTACHED

26. EQUIPMENT AND METHODS — Describe the equipment and methods to be used at each load site and disposal site. In the case of incineration, see Part 2 of Appendix 1 for further details regarding the information that must be included in your application.
NUMBER OF PAGES ATTACHED

27. METHODS OF PACKAGING AND CONTAINMENT
NUMBER OF PAGES ATTACHED

DISPOSAL SPECIFICATIONS

28. MAXIMUM QUANTITY PER DISPOSAL (cubic metres or tonnes)

29. RATE (if applicable) (cubic metres per hour or tonnes per hour)

30. FREQUENCY (disposals per day, week or month)

31. SPEED DURING DISPOSAL

32. TIME REQUIRED FOR DISCHARGE OR SINKING (minutes)

33. TRACK TO BE FOLLOWED DURING DISPOSAL
NUMBER OF PAGES ATTACHED

34. APPROVALS — List all permits, licences and reviews, including environmental impact assessments, that are required by any federal, provincial, territorial, municipal or local agency for the carrying out of the activity described in this application.

ISSUING AGENCY
TYPE OF APPROVAL
ID NO.

DATE OF APPLICATION (year/month/day)

DATE OF APPROVAL (year/month/day)

DATE OF REFUSAL (year/month/day)

35. NOTICE OF APPLICATION — Attach evidence that a notice was published under paragraph 127(2)(d) of the Act.
CLIPPING ATTACHED □

NAME OF PUBLICATION

PLACE OF PUBLICATION (city, province)

DATE OF PUBLICATION (year/month/day)

PART C — CARRIER INFORMATION (if unknown, may be provided at a later date that is prior to the start of operations)

IDENTIFICATION

36. NAME AND ADDRESS OF CARRIER
37. TELEPHONE NO.
38. FAX NO.
39. EMAIL ADDRESS

40. NAME, TITLE AND ADDRESS OF OWNER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL
41. TELEPHONE NO.
42. FAX NO.
43. EMAIL ADDRESS

44. NAME OF INDIVIDUALS RESPONSIBLE FOR LOADING OR DISPOSAL ON BEHALF OF APPLICANT (including the master)
45. TELEPHONE NO.
46. FAX NO.
47. EMAIL ADDRESS

48. NAME OR NUMBER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL

PART D — INFORMATION ON ALTERNATIVES TO DISPOSAL AT SEA

49. WASTE ASSESSMENT — See Schedule 6 to the Act.
NUMBER OF PAGES ATTACHED

50 ALTERNATIVES — Provide a comparative assessment of disposal at sea and other practicable alternatives that indicates the following:

(a) environmental impact;
(b) risk to human health;
(c) hazards (including accidents) associated with treatment, packaging, transport and disposal;
(d) economics (including energy costs); and
(e) conflicting use of resources (potential and actual).

In the case of incineration, see Part 2 of Appendix 1 for further details regarding the information that must be included in your application.

NUMBER OF PAGES ATTACHED

PART E — HISTORICAL DATA

51. PREVIOUS DISPOSAL METHODS — Describe the methods, if any, other than disposal at sea, that you have previously used to dispose of the same type of substance. Indicate dates and locations.
NUMBER OF PAGES ATTACHED

52. LOAD SITE HISTORY — For dredged material or inert, inorganic geological matter, indicate how each dredging or excavation site was used during the last 10 years.
NUMBER OF PAGES ATTACHED

PART F — CHEMICAL, BIOLOGICAL AND PHYSICAL INFORMATION

53. CHEMICAL INFORMATION — Provide a chemical characterization of the substance. If possible, attach detailed data and methods and the quality assurance and control data and methods. If no data are provided, explain why. If the substance you wish to dispose of is listed under section 1, 3, 4 or 6 of Schedule 5 to the Act, see the portion of Part 1 of Appendix 1 that pertains to that substance for further details regarding the information that must be included in your application. In the case of incineration of any substance, see Part 2 of Appendix 1.
NUMBER OF PAGES ATTACHED

54. BIOLOGICAL INFORMATION — Provide an assessment of the potential effects of the substance, including toxicity, on living marine resources. If possible, attach detailed bioassessment data and methods and the quality assurance and control data and methods. If no data are provided, explain why.
NUMBER OF PAGES ATTACHED

55. PHYSICAL INFORMATION — Provide an assessment of the potential of the substance, once disposed of at sea, to cause long-term physical effects. If possible, attach detailed physical data and methods and the quality assurance and control data and methods. If no data are provided, explain why. If the substance you wish to dispose of is listed under section 1, 3 or 4 of Schedule 5 to the Act, see the portion of Part 1 of Appendix 1 that pertains to that substance for further details regarding the information that must be included in your application.
NUMBER OF PAGES ATTACHED

PART G — PROXIMITY AND MITIGATION

56. PROXIMITY TO FACILITIES — For dredged or inert, inorganic geological material, provide a map for each load site that shows, by means of the symbols set out below, the location of the major operating and historical facilities in the site’s vicinity. Indicate your sources of information and attach a copy of the information if possible. If the source is a person, provide the person’s name, address and telephone number.

SYMBOL

FACILITIES
OPERATING
HISTORICAL
SOURCES OF INFORMATION

(a) oil refineries;
(O)
(O*)

(b) mills (specify type);
(M)
(M*)

(c) mines (specify type);
(N)
(N*)

(d) sewage outfalls;
(S)
(S*)

(e) storm drains or pipes;
(P)
(P*)

(f) shipping docks;
(D)
(D*)

(g) other industries (specify); and
(I)
(I*)

(h) other sources of pollution and contamination (specify).
(C)
(C*)

NUMBER OF PAGES ATTACHED

57. PROXIMITY TO SENSITIVE AREAS — For a new disposal site, provide a map that shows, by means of the symbols set out below, the location of all sensitive areas in the disposal site’s vicinity. Indicate your sources of information and attach a copy of the information if possible. If the source is a person, provide the person’s name, address and telephone number.

SENSITIVE AREAS
SYMBOL
SOURCES OF INFORMATION

(a) recreational areas;
(RA)

(b) spawning and nursery areas;
(SN)

(c) known migration routes of living marine resources;
(MR)

(d) sport and commercial fishing areas;
(FA)

(e) areas of natural beauty or cultural or historical importance;
(BH)

(f) areas of special scientific or biological importance;
(IS)

(g) aquaculture;
(AC)

(h) shipping lanes;
(SL)

(i) areas of the seafloor having engineering uses (mining, cables, desalination or energy conversion sites);
(EU)

(j) marine protected areas, ecological reserves and bird sanctuaries;
(PA)

(k) critical habitat for species at risk; and
(CH)

(l) other areas (describe uses, e.g. water intakes).
(XZ)

NUMBER OF PAGES ATTACHED

58. MITIGATION — Indicate measures intended to minimize the environmental, health, navigational and aesthetic impacts during loading, transport and disposal. In the case of incineration, see Part 2 of Appendix 1 for further details regarding the information that must be included in your application.
NUMBER OF PAGES ATTACHED

59. TIME RESTRICTIONS — If the load site or the disposal site is to be in the vicinity of spawning areas, migration routes or fishing areas, list the major species involved and the periods during which they are the most sensitive (active time of year).
NUMBER OF PAGES ATTACHED

If this application is to be submitted by an agent of the applicant, the applicant must complete the following authorization:
I authorize (print name) to act on my behalf as my agent in the processing of this application and to furnish, on request, supplemental information in support of this application.

Date
Name (print)
Signature

This application is made for a permit authorizing the activity described in this application. I certify that I have reviewed the information provided in this application and that, to the best of my knowledge and belief, the information is true, complete and accurate. I further certify that I am authorized to undertake the proposed activity or am acting as the applicant’s duly authorized agent.

Date
Name (print)
Signature

Telephone No.
Fax No.

Send the completed permit application, the application fee and all supporting documentation to your nearest regional Disposal at Sea Program office of Environment Canada.

APPENDIX 1
PART 1 Minimum Information Requirements (By Type of Substance) for Disposal At Sea of Waste and other Matter

Each type of substance requires different information. Provide the required information on the form in the space indicated. Attach additional pages as needed. The Minister of the Environment may require, in accordance with paragraph 127(2)(b) or 128(3)(b) of the Act, further information for the purpose of complying with Schedule 6 to the Act. In the case of disposal at sea by incineration, as referred to in section 128 of the Act, consult Part 2 of this Appendix.
The numbers below correspond to the boxes on the permit application form.

A — DREDGED MATERIAL AND INERT, INORGANIC GEOLOGICAL MATTER

17 Substance to be Disposed Of at Sea
For soil or sediment, indicate the relative presence of

(a) boulders and cobble;
(b) gravel;
(c) sand;
(d) silt;
(e) clay;
(f) peat and other organic soil components; and
(g) other items in the soil or sediment (e.g. wood waste, seaweed).

For rock, indicate the relative presence of

(a) sedimentary rock;
(b) metamorphic rock; and
(c) igneous rock.

53 Chemical Information
Identify the presence of the following in any soil, sediment and pore water being disposed of:

(a) cadmium;
(b) mercury;
(c) other metals identified through a full metal scan;
(d) total polychlorinated biphenyls (PCBs);
(e) total polycyclic aromatic hydrocarbons (PAHs);
(f) total organic carbon; and
(g) other chemicals that may be specified by the Minister for the purpose of complying with Schedule 6 to the Act.

55 Physical Information
Provide the following information in respect of the waste to be disposed of:

(a) the grain size of any soil or sediment; and
(b) any other physical data that may be specified by the Minister for the purpose of complying with Schedule 6 to the Act.

B — FISH WASTE

17 Substance to be Disposed Of at Sea
Provide the following information in respect of the waste to be disposed of:

(a) its species;
(b) its type (e.g., shells or offal); and
(c) its source.

C — SHIPS, AIRCRAFT, PLATFORMS AND OTHER STRUCTURES (as described in section 3 of Schedule 5 to the Act)

17 Substance to be Disposed Of at Sea
Provide the following information in respect of the waste to be disposed of, if applicable:

(a) its name;
(b) the location of its registry;
(c) its model or official number;
(d) its dimensions;
(e) its weight (dead weight tonnage);
(f) its principal materials of construction;
(g) its owner’s name and address; and
(h) its state of seaworthiness.

53 Chemical Information
Describe any cargo, fuel and hazardous materials, including chemicals, left on board.

55 Physical Information
Provide the following information in respect of any ship or aircraft to be disposed of:

(a) its last cargo;
(b) the type of engine, if left on board; and
(c) the nature and weight of any ballast left on board.

D — BULKY SUBSTANCES (as described in section 6 of Schedule 5 to the Act)

17 Substance to be Disposed Of at Sea
Describe the substance’s

(a) principal components and the composition of those components;
(b) dimensions (metres);
(c) weight (tonnes); and
(d) origin and the process that gave rise to it.

Provide information demonstrating that the substance meets the definition and criteria described in section 6 of Schedule 5 to the Act.

53 Chemical Information
Describe any contamination of the substance by hazardous materials, including chemicals.

E — UNCONTAMINATED ORGANIC MATTER OF NATURAL ORIGIN

17 Substance to be Disposed Of at Sea
Describe the substance’s

(a) principal components and the composition of those components; and
(b) origin and the process that gave rise to it.

PART 2 Minimum Information Requirements for Incineration

For applications under section 128 of the Act

If this is an application under section 128 of the Act to incinerate a substance to avert an emergency, provide the required information on the form in the space indicated. Attach additional pages as needed. The Minister of the Environment may require, in accordance with paragraph 128(3)(b) of the Act, further information for the purpose of complying with Schedule 6 to the Act. Contact your nearest regional Disposal at Sea Program office of Environment Canada before preparing or submitting an emergency permit application.
The numbers below correspond to the boxes on the permit application form.

ALL SUBSTANCES

17 Substance to be Disposed Of at Sea
Provide the following information in respect of the substance to be incinerated:

(a) its principal components and the composition of those components;
(b) the products of its combustion and the rate of their production; and
(c) its origin and the process that gave rise to it.

26 Equipment and Methods
Describe the following in respect of the proposed incineration:

(a) the incineration equipment to be used;
(b) the air pollution control equipment to be used;
(c) the monitoring and control systems in place;
(d) the stack dimensions;
(e) the combustion temperature;
(f) the retention time;
(g) the combustion and destruction efficiency; and
(h) the proposed method of loading and storage.

50 Alternatives
Include a justification for the use of incineration versus other disposal options.

53 Chemical Information
Provide the results of the latest tests on stack emissions for particulate matter, hydrogen chloride (HCl), carbon monoxide (CO), dioxins and furans.

58 Mitigation
Describe the following in respect of the proposed incineration:

(a) the methods of complying with applicable noise by-laws;
(b) the methods of managing ash and minimizing fugitive emissions;
(c) the methods of managing wastewater to comply with provincial or municipal discharge limits;
(d) the methods of preventing hazards to other ships;
(e) the methods of spill response and contingency plans in the event of a spill;
(f) the methods of emergency shutdown; and
(g) the qualifications of the operating personnel.

APPENDIX 2Minimum Information Requirements for Disposal At New Disposal Sites and on Ice

Provide the information required for the waste that you are applying to dispose of on the form in the space indicated. Attach additional pages as needed. The Minister of the Environment may require, in accordance with paragraph 127(2)(b) or 128(3)(b) of the Act, further information for the purpose of complying with Schedule 6 to the Act. Contact your nearest regional Disposal at Sea Program office of Environment Canada before collecting data on a new disposal site.
The numbers below correspond to the boxes on the permit application form.

A — DISPOSAL AT A NEW DISPOSAL SITE FOR DREDGED MATERIAL OR INERT, INORGANIC GEOLOGICAL MATTER

24 Disposal Site(s)
Provide information regarding the following in respect of the proposed disposal site:

(a) bathymetry;
(b) sediment transport;
(c) salinity;
(d) current flows representative of the whole water column at the site;

(e) the presence of the following chemicals in the sediment and pore water:

(i) cadmium,
(ii) mercury,
(iii) polychlorinated biphenyls (PCBs), and
(iv) total polycyclic aromatic hydrocarbons (PAHs);

(f) benthic and epibenthic communities in the site’s vicinity, unless the proposed disposal site is a “shallow water, high energy” disposal site; and
(g) any other information that may be specified by the Minister for the purpose of complying with Schedule 6 to the Act.

B — DISPOSAL ON ICE

24 Disposal Site(s)
Provide the following information in respect of the proposed disposal site:

(a) area of ice to be used;
(b) thickness of ice (metres);
(c) estimated date of ice breakup (year/month/day);
(d) estimated location of ice breakup and material deposition (latitude and longitude);
(e) estimated time from breakup to melting (days); and
(f) estimated depth of water (metres).

SCHEDULE 2(Section 3)

Environment
Canada

Environnement
Canada

Application for Permit Renewal (Disposal at Sea)*

Return to footnote *Ce formulaire est disponible en français.

Application Identification
(EC OFFICE USE ONLY)
Name:
Number:

Permits are issued in accordance with Division 3 of Part 7 of the Canadian Environmental Protection Act, 1999 (the “Act”). “Disposal” has the same meaning as in subsection 122(1) of the Act. Information provided on this form will be used to evaluate the application for a permit renewal. Information collected is intended to verify that no conditions that informed the decision to issue the original permit have changed since the original permit application.

Permit To Be Renewed

Original Permit No.

Original Permit Expiry Date(year/month/day)

PART A — APPLICANT INFORMATION

IDENTIFICATION

1. NAME OF APPLICANT — Indicate the name that is to appear on the permit.
2. TELEPHONE NO.
3. FAX NO.
4. EMAIL ADDRESS

5. ADDRESS
6. TYPE OF BUSINESS

7. NAME OF INDIVIDUAL(S) RESPONSIBLE FOR PROPOSED ACTIVITY

8. TELEPHONE NO. (if different from box 2)

9. FAX NO. (if different from box 3)

10. EMAIL ADDRESS (if different from box 4)

11. NAME OF TECHNICAL CONTACT(S) FOR PROPOSED ACTIVITY
12. TELEPHONE NO.
13. FAX NO.
14. EMAIL ADDRESS

PART B — INFORMATION ON PROPOSED ACTIVITY

GENERAL INFORMATION

15. DESCRIPTION OF ACTIVITY — Describe in detail any changes to the information provided in the original permit application.
NUMBER OF PAGES ATTACHED

16. TERM OF PERMIT REQUESTED ON RENEWAL (maximum one year)fromyear/month/day

toyear/month/day

17. TOTAL QUANTITY (cubic metres or tonnes) — Indicate the maximum quantity requested for disposal under the renewed permit.

18. NEW APPROVALS — List all permits, licences and reviews, including environmental impact assessments, that are required by any federal, provincial, territorial, municipal or local agency for the carrying out of the activity described in this application and were received since the original permit application was submitted.

ISSUING AGENCY
TYPE OF APPROVAL
ID NO.

DATE OF APPLICATION (year/month/day)

DATE OF APPROVAL (year/month/day)

19. NOTICE OF APPLICATION — Attach evidence that a notice was published under paragraph 127(2)(d) of the Act.
CLIPPING ATTACHED □

NAME OF PUBLICATION

PLACE OF PUBLICATION (city, province)

DATE OF PUBLICATION (year/month/day)

PART C — CARRIER INFORMATION (if unknown, may be provided at a later date that is prior to the start of operations)

IDENTIFICATION

20. NAME AND ADDRESS OF CARRIER
21. TELEPHONE NO.
22. FAX NO.
23. EMAIL ADDRESS

24. NAME, TITLE AND ADDRESS OF OWNER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL
25. TELEPHONE NO.
26. FAX NO.
27. EMAIL ADDRESS

28. NAME OF INDIVIDUALS RESPONSIBLE FOR LOADING OR DISPOSAL ON BEHALF OF APPLICANT (including the master)
29. TELEPHONE NO.
30. FAX NO.
31. EMAIL ADDRESS

32. NAME OR NUMBER OF SHIP, AIRCRAFT, PLATFORM OR STRUCTURE USED TO CARRY OUT DISPOSAL

If this application is to be submitted by an agent of the applicant, the applicant must complete the following authorization:
I authorize (print name) to act on my behalf as my agent in the processing of this application and to furnish, on request, supplemental information in support of this application.

Date
Name (print)
Signature

This application is made for the renewal of a permit authorizing the activity described in this application. I certify that I have reviewed the information provided in the original permit application and that it is still complete and accurate with the exception of updated information provided in this application for renewal. I certify that I have reviewed the information provided in this application and that, to the best of my knowledge and belief, the information is true, complete and accurate. I further certify that I am authorized to undertake the proposed activity or am acting as the applicant’s duly authorized agent.

Date
Name (print)
Signature

Telephone No.
Fax No.

Send the completed permit renewal application, the application fee and all supporting documentation to your nearest regional Disposal at Sea Program office of Environment Canada.