Fisa de prezentare si declaratie
FISA DE PREZENTARE SI DECLARATIE
1. Date generale:
Denumirea unită?ii, firmeietc., _________________________________________________
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Adresa,______________________________________________________________________
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telefon, fax:___________________________________________________________________
Amplasamentul:_______________________________________________________________
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Profilul de activitate___________________________________________________________
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Forma de proprietate___________________________________________________________
Regimul de lucru(ore/zi, zile/săptămână, zile/an)_____________________________________
2. Date specifice activită?ii:
a) Activitatea desfă?urată:(Se prezintă activitatea specifică desfă?urată, cu informa?ii complete, inclusiv descrierea proceselor tehnologice)___________________________________
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b) Dotări(Dotările specifice: clădiri -cu suprafa?a spa?iilor ocupate, utilaje, instala?ii, ma?ini, aparate, mijloace de transport utilizate în activitate etc.)_________________________________
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c) Bilan?ul de materiale
Cantită?ile de materii prime, auxiliare ?i combustibili,
intrate/intra?i în process__________________________________________________________
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Pierderile pe faze de fabrica?ie sau de activitate si emisiile în mediu (inclusiv deseuri)
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Cantită?ile de produse si subproduse rezultate. Bilan?ul acestor materiale, care serveste ?i la întocmirea ?i revizuirea bilan?ului de mediu, trebuie să se închidă cu eroarea acceptată de metodologia de calcul folosită_____________________________________________________
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d) Utilită?i-Modul de asigurare cu utilită?i (apă, canal, energie etc.): surse, cantită?i, volume._______________________________________________________________________
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3. Surse de poluan?i ?i protec?ia factorilor de mediu:
Protec?ia calită?ii apelor
Sursele de ape uzate ?i compu?ii acestor ape__________________________________________
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Sta?iile ?i instala?iile de epurare sau de preepurare a apelor uzate, randamentele de re?inere a poluan?ilor, locul de evacuare (emisar, canalizare publică, canalizare, platformă industrială) __________________________________________________________________________________________________________________________________________________________
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Poluan?ii evacua?i în mediu sau în canalizări publice ori în alte canalizări (în mg/l ?i kg/zi) _____________________________________________________________________________
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Protec?ia atmosferei
Sursele ?i poluan?ii pentru aer_____________________________________________________
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Instala?ii pentru colectarea, epurarea ?i dispersia gazelor reziduale ?i a pulberilor_____________
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Poluan?ii evacua?i în atmosferă (în mg/mc ?i g/s)______________________________________
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Protec?ia împotriva zgomotului ?i vibra?iilor
Sursele de zgomot ?i de vibra?ii___________________________________________________
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Dotările, amenajările ?i măsurile de protec?ie împotriva zgomotului ?i vibra?iilor_____________
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Nivelul de zgomot ?i de vibra?ii produs______________________________________________
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Protec?ia solului ?i subsolului
Sursele posibile de poluare a solului ?i a subsolului.____________________________________
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_____________________________________________________________________________ Măsurile, dotările ?i amenajările pentru protec?ia solului ?i a subsolului____________________
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Protec?ia împotriva radia?iilor
Sursele de radia?ii din activitate____________________________________________________
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Dotările, amenajările ?i măsurile pentru protec?ia împotriva radia?iilor_____________________
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Nivelul radia?iilor emise în mediu__________________________________________________
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Protec?ia fondului forestier
Situa?ia afectării fondului forestier__________________________________________________
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Lucrările ?i măsurile pentru diminuarea ?i eliminarea impactului negativ produs asupra vegeta?iei ?i ecosistemelor forestiere________________________________________________
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Protec?ia ecosistemelor, biodiversită?ii ?i ocrotirea naturii
Sursele posibile de afectare a ecosistemelor acvatice ?i terestre, a monumentelor naturii, a parcurilor na?ionale ?i a rezerva?iilor naturale_________________________________________
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Măsurile pentru protec?ia ecosistemelor, biodiversită?ii ?i pentru ocrotirea naturii, în general _____________________________________________________________________________
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Protec?ia peisajului ?i a zonelor de interes tradi?ional
Modul de încadrare a obiectivului în peisaj___________________________________________
__________________________________________________________________________________________________________________________________________________________ Măsuri ?i amenajări pentru protec?ia peisajului ?i a zonelor de interes tradi?ional_____________
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Gestiunea de?eurilor
Sursele de de?euri, tipuri, compozi?ie ?i cantită?i de de?euri rezultate______________________
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Modul de gospodărire a de?eurilor; depozitare controlată, transport, tratare, refolosire, distrugere, integrare în mediu, comercializare__________________________________________________
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Gestiunea substan?elor ?i preparatelor periculoase
Substan?ele ?i preparatele periculoase utilizate/de?inute, cantită?ile utilizate/de?inute ?i fi?ele de securitate ale acestora____________________________________________________________
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-Modul de gospodărire, măsurile, dotările ?i amenajările pentru protec?ia mediului___
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AZBEST : Cantitate sau suprafata _________________________________________________
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PCB :________________________________________________________________________
Gestiunea ambalajelor
Tipurile si cantită?ile de ambalaje folosite____________________________________________
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Modul de gospodărire a ambalajelor ?i măsuri pentru protec?ia mediului___________________
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Încadrarea în planurile de urbanism ?i amenajare a teritoriului____________________________
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Modul de încadrare a obiectivului în cerin?ele planurilor de urbanism ?i amenajare a teritoriului. _____________________________________________________________________________
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Protec?ia a?ezărilor umane
Distan?a fa?ă de a?ezările umane, localită?ile ?i popula?ia eventual afectată__________________
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Măsurile, dotările ?i amenajările pentru protec?ia a?ezărilor umane________________________
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Respectarea prevederilor conven?iilor interna?ionale la care România a aderat._______________
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Amenajările, dotările ?i măsurile pentru respectarea conven?iilor interna?ionale, a reglementărilor comunitare ?i ale organismelor O.N.U. la care România a aderat._____________
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Alte date ?i informa?ii privind protec?ia mediului______________________________________
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Se vor prezenta ?i alte date specifice activită?ii sau solicitate de autoritatea pentru protec?ia mediului, care au legătură cu protec?ia factorilor de mediu ?i planul de interven?ie în caz de poluări accidentale.______________________________________________________________
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Reconstruc?ia ecologică__________________________________________________________
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Lucrări ?i măsuri pentru refacerea mediului deteriorat, precum ?i pentru men?inerea unui ecosistem corespunzător în zonă____________________________________________________
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Monitorizarea mediului___________________________________________________________
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Dotări ?i măsuri privind instruirea personalului, managementul exploatării ?i analiza periodică a propunerii de conformare pentru controlul emisiilor de poluan?i, supravegherea calită?ii mediului ?i monitorizarea activită?ilor de protec?ie a mediului.___________________________________
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DATA: SEMNATURA: