New South Wales Consolidated Regulations

ENVIRONMENTALLY HAZARDOUS CHEMICALS REGULATION 2008 - SCHEDULE 1

SCHEDULE 1 – Form

(Clause 9)

Environment Protection Authority

Environmentally Hazardous Chemicals Act 1985 (section 45 (3))

Receipt for taking sample of substance or removing substance or container

This receipt is to:
[name of occupier of premises]
[address of premises]
I [name of authorised officer] an authorised officer under the Environmentally Hazardous Chemicals Act 1985 , acknowledge by this receipt that:
(delete whichever of the following does not apply)

I have today taken from the above premises a sample of the following substance in the following quantity:
[name or description of substance]
[approximate quantity of substance]

I have today removed from the above premises the following substance or the following containers:
[name or description of substance]
[size and number of containers]