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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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