3.3 (Form 3.3)

3종화학물질 시설의 신고 (Declaration of Schedule 3 Plant)

(각 시설에 대하여 작성하시오.) (Please complete one form for each plant.)

□ 시설코드(Plant Code) :

□ 설비장소코드(Plant Site Code) :

/. 시설명(Name of Plant) :

/. 소유주, 회사 또는 설비장소를 운영하는 기업명(The name of the owner, company, or enterprise operating the plant) :

/. 설비장소내의 해당시설의 정확한 위치(The precise location of the plant within the plant site) :

특정구조번호(Specific structure number, if any) :

특정건물번호(Specific building number, if any) :

/. 본 시설에 대한 추가사항이 있으면 임의로 작성하시오(Identify the attachments for additional information on a voluntary basis on this plant(if available)) :

□ 3종화학물질 시설의 주요 활동 (Main activities of Scheldule 3 plants)

/. 주요활동코드를 표시하시오(Use main activity codes to describe main activities of the plant) :

생산 (Production)(B01)	□	가공 (Processing)(B02)	□
소비 (Consumption)(B03)	□	저장 (Storage)(B04)	□
배분 (Re-packaging, Distribution)(B05)	□	연구·개발 (R&D)(B06)	□

/. 생산제품그룹코드(부록 2 참조)(Use product group codes (see appendix 2) to describe main activities of the plant in terms of product group(s)) :

[/. 본 시설에서 1종화학물질이 불가피한 부산물로서 전체 생산량의 3%를 초과하지 않는 양으로 생산되거나 생산된적이 있습니까? (Is or was a chemical specified in subparagraph 8 (a) (i) of Article Ⅱ of the CWC produced at the facility as an unavoidable by-product in an amount not exceeding 3 percent of the total product?)]                                                                          □