Application For A Dangerous Goods Site Licence - Government Of Western Australia Page 14
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Application section – return to Resources Safety
Contact details
(all applicants)
Phone
Facsimile
Mobile
Email
ABN
Business street address
(mandatory)
Unit no.
Street no.
Lot no.
Street
Town/suburb
State
Postcode
Postal address
(complete if different from above)
Unit no.
Street no.
Lot no.
Street
PO box no.
Town/suburb
State
Postcode
3. Site to be licensed
Property trading name
(if applicable)
Address
Unit no.
Street no.
Lot no.
Street
Town/suburb
Postcode
Site phone
Site fax
Site email
Additional location information
(if there is no valid street address)
Global Positioning System (GPS) coordinates
(if available)
AND/OR
Geographic (GDA94):
Latitude
Longitude
Projected (MGA94):
Easting
Northing
Zone
Land title information
(as appropriate to site being endorsed)
Certificate of title (CT) number
Minesite tenement number
Major supplier(s) of dangerous goods to this site
Is the site a potential Major Hazards Facility?
Yes
No
(if applicable)
Is the site a potential Mining Operation?
Yes
No
(if applicable)
Does this site handle, store or process more than 1000 litres of hazardous wastes that are
Yes
No
dangerous goods?
DGS REV 2
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