Industrial Wastewater Discharge Service Application
Applicant Information
Company/Organization Name
Registration Number
Contact Person
Phone Number
Email Address
Company Address
Industrial Facility Details
Facility Name
Facility Address
Type of Industry
Production Capacity
Wastewater Discharge Details
Estimated Daily Discharge Volume (m³)
Discharge Location
Brief Description of Wastewater Characteristics
Treatment Methods Employed
Attachments
Supporting Documents
Declaration
I hereby declare that the information provided is accurate and complete.