"Application for Licence to Purchase a Regulated Substance Under the Ozone Layer Protection Regulations" - Prince Edward Island, Canada

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Application for Licence to Purchase a
Regulated Substance Under the
Ozone Layer Protection Regulations
Information on this form is collected as required under Section 13 of the Ozone Layer Protection Regulations, made
under Section 25 of the Environmental Protection Act.
For Office Use Only
Licence No.
Fee
mm/dd/yy
Company Information
New Application
Renewal (Licence No. _________________ )
Company Name:
Manager:
Address:
Telephone:
City:
Postal Code:
Type of Work (check as many as applicable)
Residential
Commercial
Industrial
Small Appliance
Motor Vehicle
Wholesaler
Employee Information (Registered Handlers)
Name
Certification No.
Name
Certification No.
Recovery/Recycling Equipment
* Rv – recovery
Ry – recycling
Manufacturer
Model No.
Year
Type *
Declaration by Applicant:
After taking all necessary steps to properly inform myself of the facts associated with this application, I certify that the
above information is correct, accurate and complete to the best of my knowledge.
Applicant Name
Title/Position
Signature
Date
The completed application form, accompanied by the appropriate fee, (made payable to the Minister of Finance) should
be submitted to:
Department of Agriculture and Land
Inspection Services
31 Gordon Drive
PO Box 2000
Charlottetown, PE C1A 7N8
Phone: 902-368-5280
Fax: 902-368-5526
Application for Licence to Purchase a
Regulated Substance Under the
Ozone Layer Protection Regulations
Information on this form is collected as required under Section 13 of the Ozone Layer Protection Regulations, made
under Section 25 of the Environmental Protection Act.
For Office Use Only
Licence No.
Fee
mm/dd/yy
Company Information
New Application
Renewal (Licence No. _________________ )
Company Name:
Manager:
Address:
Telephone:
City:
Postal Code:
Type of Work (check as many as applicable)
Residential
Commercial
Industrial
Small Appliance
Motor Vehicle
Wholesaler
Employee Information (Registered Handlers)
Name
Certification No.
Name
Certification No.
Recovery/Recycling Equipment
* Rv – recovery
Ry – recycling
Manufacturer
Model No.
Year
Type *
Declaration by Applicant:
After taking all necessary steps to properly inform myself of the facts associated with this application, I certify that the
above information is correct, accurate and complete to the best of my knowledge.
Applicant Name
Title/Position
Signature
Date
The completed application form, accompanied by the appropriate fee, (made payable to the Minister of Finance) should
be submitted to:
Department of Agriculture and Land
Inspection Services
31 Gordon Drive
PO Box 2000
Charlottetown, PE C1A 7N8
Phone: 902-368-5280
Fax: 902-368-5526