"Application for Registered Handler of a Regulated Substance" - Prince Edward Island, Canada

ADVERTISEMENT
ADVERTISEMENT

Download "Application for Registered Handler of a Regulated Substance" - Prince Edward Island, Canada

268 times
Rate (4.4 / 5) 16 votes
 
Application for Registered Handler
of a Regulated Substance
Information on this form is collected as required under Section 6 of the Ozone Layer Protection Regulations, made under
Section 25 of the Environmental Protection Act.
 
For Office Use Only
 
 
 
Cert. No.
Fee
mm/dd/yy
 
Registrant Information
Name:
Home Phone:
Address:
City:
Postal Code:
Email:
Company Name:
 
Type of Work (Check all that apply)
 
Mobile
Residential/Commercial/Industrial
Small Appliance
Wholesaler
 
 
Trade Qualifications (Check one and provide the additional information)
 
Certificate of Qualification in
 
Indentured Trainee or Apprentice
 
Name of Supervising Journeyperson
 
Handler Experience
 
Handler Certification No.
 
 
Environmental Awareness Training
 
HRAI Certification No.
 
 
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
Signature
Date
 
 
 
The completed application form, accompanied by the $100 application fee. Please make cheques payable to the Minister
of Finance.
 
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 Registered Handler
of a Regulated Substance
Information on this form is collected as required under Section 6 of the Ozone Layer Protection Regulations, made under
Section 25 of the Environmental Protection Act.
 
For Office Use Only
 
 
 
Cert. No.
Fee
mm/dd/yy
 
Registrant Information
Name:
Home Phone:
Address:
City:
Postal Code:
Email:
Company Name:
 
Type of Work (Check all that apply)
 
Mobile
Residential/Commercial/Industrial
Small Appliance
Wholesaler
 
 
Trade Qualifications (Check one and provide the additional information)
 
Certificate of Qualification in
 
Indentured Trainee or Apprentice
 
Name of Supervising Journeyperson
 
Handler Experience
 
Handler Certification No.
 
 
Environmental Awareness Training
 
HRAI Certification No.
 
 
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
Signature
Date
 
 
 
The completed application form, accompanied by the $100 application fee. Please make cheques payable to the Minister
of Finance.
 
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