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11
Arab Republic Egypt The Cabinet of Ministers )Egyptian Environmental Affairs Agency (EEAA
)()Environmental Screening Form (A
) (General Information1. ______________________________________________ : ((Project title 2. : )---- ______________________ ())Residential, commercial, Tourstic, Industrial, others
3. ) (: )(Project developer/applicant ) ____________________________________ (: )Name of owner & contact (person ________________________________________________ : ________________________________________________ )(Address : : _____________________ _____________________ )(.Fax No )(.Telephone No 4. : (.Estimated capital investment/ L.E ___________________________________________________________ _____________________________________ 5. : )(Concerned licensing authority 6. )- (: ________________________________)New project or extension of existing
(project 7. :)(Project phases and expected starting date
_____________________________________________ _____________________________________________ _____________________________________________
: )(Construction : )(Operation : )Future
21
(expansion
13
.(8. : ) - - - .. (Brief project description: Production capacity- Raw materials- Sources of Energy)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ :9. (Project site location) : (Address) 2 ( ) (Total project area/ M2) :01. (Any additional information) ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
Certification . I bereby certify that the information given is accurate and true to the best of my knowledge, and in case of any consequent changes prompt notification will be made to the EEAA.
: _________________________________________Certified by
: / _________________________________________ .LD No./passport No : Reference _________________________________________ : Date _________________________________________
14
2 - / . . "" : )1( " " )2( " "
1-2 : 051 . . ) 52 ) (. . . . . . 001 / ) ( 05 / . . 0051 . . 002 . 05 / . . . . . 001 / ) ( 005 / . ) ( . 01 / .51
. . . "" . )( . . 0001 . . / 057 . 005 / . 0001 . . . ) ( . . 05 ) ( 000 51 . - .
03 . . .
. .
05 . 51 % .61
0051 . . **** 2-2 1-2-2 ) ( )( . 2-2-2 . 3-2-2 . 4-2-2 06 . 5-2-2 . . . / . . . . . "" "" 03 . . 6-2-2 - )( - 7-2-2 8-2-2 7-4-2 8-4-2 9-4-2 5-2
71
Arab Republic Egypt The Cabinet of Ministers )Egyptian Environmental Affairs Agency (EEAA
)( )Environmental Screening Form (B.
) (General Information1. ______________________________________________ : ((Project title 2. : )---- ______________________ ())Residential, commercial, Tourstic, Industrial, others) (Type of project
3. ) ( )(Investor/ applicant ) ____________________________________ (:)(Project Developer or applicant
: )(reference ________________________________________________ : ________________________________________________ )(Address : : _____________________ _____________________ )(.Fax No )(.Telephone No Information to be completed by the EEAA officials
________________________________________________
Receivale Date
/
/
: / : /Date of application
: .Serial No
81
_____________________________ ____
) (
)(Estimated Capital Investment, L.E _______________________________
_____ (Concerned Licensing Authority & Address ___________________________________________________________ __________ __________________________________ )/( )(New/ Extension )(Project phases and expected starting dates _____________________________ : )(Construction _____________________________ : )(Operation _____________________________ : )(Future Extension )(Brief Project description 4.
_____________________________ )(Project basic features & Production Capacity ___________________________________________________________ ___________________________________________________________ ____________________________________________ )(Objectives ___________________________________________________________ ___________________________________________________________ _____________________________________________ )(Need for justification _________________________________________________________ _________________________________________________________ ____________________________________________ )(Basic components _________________________________________________________ _________________________________________________________91
_________________________________________________________
20
) ( Technological systems. Accompanied as much as possible with layout and Operational charts and diagrams showing inputs & outputs (including wastes)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 5. (Alternatives Considered) ___________________________________ (Sites) ___________________________________ (Technologies)
___________________________________ ___________________________________
(Are there available studies of similar projects: indicate source)
(Designs) ) (Materials ( )
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (Project location and site) 6. ___________________________________ (Address) ___________________________________________________________ 2 ___________________________________ (Total Area, m2) ( (Please attach a detailed map with a suitable scale to indicate clearly the site, transportation routes and pipelines, its boundaries and neibouring uses).
21
7. )(A brief description of the construction phases and basic construction methods
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ) (..)(Inputs during construction and operation (In case of industrial projects, raw materials & for other projects, state kind of .)resources
- 11 Inputs of water, energy, and manpower, see table
Operation phase
Construction phase
Inputs
- Water-sanitary
- Water-Process
- Water- other use
- Energy/ electricity
/ ) ()Energy/fuel (liquid,Solid, gas
/ Energy/ renewable sources
22
Manpower
Others
1 : Inputs during construction and operation phases 7. Outputs during construction and operation phases
2 : ) ( ) (.. End products (industrial project): or other outputs (all projects, see table 2)
Operation phase
Construction phase
Emissions, discharges and wastes
Type of output
Sulphur dioxide Air
Air
Particular matter
Smoke Odour Noise OthersAir Air Air Air
23
Sewage Water
Domestic waste
.Solid waste
Industrial waste
Solid waste
Hazardous waste
Solid waste
2: Outputs during construction and operation
8. : ) .( .. Other information deemed important particularly with regard to safeguarding personnel and environment e.g. safety and fire fighting facilities.
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
24
( ) ()Brief description of the environment (Baseline information
* General area description and most important features as
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ )(Present infrastructure and services ____________________________ : )(Water _ ____________________________ : )(Electricity _ ____________________________ : )(Sewage _ ____________________________ _ :)(Solid waste disposal
____________________________ )(Hospital _ :
Fragile or sensitive ecosystems (critical or high valued ecosystems) that are present
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ________________________________)(Description of archeological & historical areas
___________________________________________________________ ___________________________________________________________
52
________________________________)(Description of protected areas
___________________________________________________________ ___________________________________________________________ _____________________________)(Description of recreational & touristic areas
- )(Preliminary analysis of impacts1- ) ()Air Quality (Potential effects on air quality
_________________________________________ _ : _________________________________________ )(Construction phase _ _________________________________________ _ : )(Operation phase _________________________________________ _ : _________________________________________ )(Site _ _________________________________________ _ _________________________________________ _ )(Neighboring area _________________________________________ _ _________________________________________ _ : )(Tran boundary _________________________________________ _
62
2- .() ... Clarify whether projects or sites that are considered sensitive areas exist nearby the project sites (as hospitals, schools, residential areas etc.)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________Water Quality 3-
(Will the activity cause a significant change on the water availability, use, hydrology, drainage, temperature or quality?).
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
27
( ) (Are there existing hazard probabilities- explain the type, quantity and impact)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (Will the activity affect surface water use?)
_______________________________________________ : _______________________________________________ (Fisheries) _______________________________________________ : _______________________________________________ (Tourism and recreation) _______________________________________________ : _______________________________________________ (Other activities)Soil Quality 4-
(Would the activity provoke a significant change on land use, landscape, fertility, vegetation cover, biodiversity or quality?)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 5- Please identify the impact of changes of soil quality on different activities
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________28
___________________________________________________________ ___________________________________________________________ 6- (Please explain if there are any other potential or significant impacts resulting from this activity)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (Mitigating measures) -
(Air emissions) 1- ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
29
2- ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (Solid and hazardous waste) 3- ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (Other mitigating measures) 4- ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
(Waste water)
30
- (Inter-institutional and public involvement)
(Is other any contact with public authorities or others concerning the project)
___________________________________________________________ ___________________________________________________________ ___________________________________________________________
Certification - . . .. I hereby certify that the information given is accurate and true to the best of my knowledge, and in case of any consequent changes, prompt notification will be made to EEAA.
______________________________________
:
(Certified by)______________________________________ / :
(.L.D. No./ passport No)______________________________________ _______________________ :(Date)
:
(Reference)
31
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