You are on page 1of 35

Ph lc 1 S quy trnh lp, thm nh v ph duyt n bo v mi trng chi tit

(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

Ch c s

Lp

H s n bo v mi trng chi tit


Np

H s cha y

Vn phng tip nhn H s ca C quan c thm quyn thm nh, ph duyt


H s y

Np li ph duyt sau khi chnh sa, b sung

C quan c thm quyn thm nh, ph duyt (C quan thng trc thm nh)

Ni dung n khng ng quy nh

T chc thm nh ni dung n


Ni dung n ng quy nh

Kim tra thc t (bt buc); ly kin chuyn gia (nu cn thit)
Thng qua khng cn chnh sa n

Khng thng qua n Yu cu chnh sa, b sung n

Thng bo kt qu thm nh

Thng qua cn chnh sa n

Ph duyt n (C quan c thm quyn thm nh, ph duyt)

Ph lc 2 Cu trc v ni dung ca n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

MC LC DANH MC T NG VIT TT Lit k y cc t ng c vit tt, cc k hiu c s dng trong n bo v mi trng chi tit km theo tn y ca tng t ng, tng k hiu. DANH MC BNG/BIU Lit k chnh xc m s, tn gi ca tt c cc bng/biu c to lp v th hin trong n bo v mi trng chi tit km theo ch dn s trang ca tng bng/biu. DANH MC HNH Lit k chnh xc m s, tn gi ca tt c cc hnh (bn , s , biu , nh v cc hnh v khc) c to lp v th hin trong n bo v mi trng chi tit km theo ch dn s trang hoc m s ph lc. M U 1. Vic thnh lp v tnh trng hin ti ca c s - Tm tt qu trnh thnh lp c s: C s c thnh lp theo quyt nh ca ai/cp no, s v ngy ca vn bn hay quyt nh thnh lp; c hay khng c ng k u t, nu c th nu r s v ngy ca vn bn ng k; c hay khng c cp giy chng nhn u t, nu c th nu r s v ngy ca giy chng nhn u t, cc thng tin lin quan khc (sao v nh km cc vn bn phn ph lc ca n). - Nu r vic thnh lp c s c ph hp vi cc quy hoch lin quan c ph duyt hay khng (quy hoch s dng t, quy hoch pht trin kinh t - x hi, quy hoch pht trin ngnh, cc quy hoch lin quan khc), c ph hp vi ch trng pht trin kinh t - x hi ti a bn hay khng. - Trng hp a im ca c s t ti khu sn xut, kinh doanh, dch v tp trung (khu kinh t, khu/cm cng nghip, khu ch xut, khu cng ngh cao, khu/cm sn xut/kinh doanh/dch v tp trung khc) th phi nu r tn ca khu/cm, s v ngy ca vn bn chp thun ca Ban qun l khu/cm (sao v nh km vn bn phn ph lc ca n). - Nu r tnh trng hin ti ca c s (thuc loi no theo quy nh ti khon 1 iu 3 Thng t ny). 2. Cn c lp n bo v mi trng chi tit 2.1. Cn c v php l Lit k y cc vn bn sau y (s, ngy ban hnh, c quan ban hnh, ni dung trch yu ca vn bn): - Vn bn l cn c lp n bo v mi trng chi tit, k c cc tiu chun v mi trng cn hiu lc thi hnh, quy chun k thut v mi trng c lin quan.
2

- Vn bn ca ban qun l khu sn xut, kinh doanh, dch v tp trung chp thun cho c s u t vo khu ny (trng hp a im ca c s nm trong khu sn xut, kinh doanh, dch v tp trung). 2.2. Cn c v thng tin Lit k cc ti liu (tn, tc gi, xut x thi gian, ni xut bn hoc ni lu gi) c nhng thng tin, s liu c s dng cho vic lp n bo v mi trng chi tit. 3. T chc lp n bo v mi trng chi tit - Nu tm tt v vic t chc lp n bo v mi trng chi tit ca ch c s; trng hp c thu t vn th nu r: Tn n v t vn km theo a ch lin h, h v tn ngi ng u n v t vn v phng tin lin lc (in thoi, fax, hp th in t). - Danh sch nhng ngi trc tip tham gia lp n bo v mi trng chi tit, bao gm ngi ca c s v ca n v t vn km theo ch dn v hc hm, hc v, chuyn ngnh o to ca tng ngi. Chng 1. M T TM TT C S V TNH HNH THC HIN CNG TC BO V MI TRNG QUA CA C S 1.1. Tn ca c s Nu y , chnh xc tn gi hin hnh ca c s (thng nht vi tn ghi trang ba v trang ph ba ca n bo v mi trng chi tit ny). 1.2. Ch c s Nu y h, tn v chc danh ca ch c s km theo ch dn v a ch lin h, phng tin lin lc (in thoi, fax, hp th in t). 1.3. V tr a l ca c s - M t v tr a l ca c s: Nu c th v tr thuc a bn ca n v hnh chnh t cp thn v/hoc x tr ln; trng hp c s nm trong khu sn xut, kinh doanh, dch v tp trung th phi ch r tn khu/cm ny trc khi nu a danh hnh chnh; ta cc im khng ch v tr ca c s (nu c). - M t cc i tng t nhin, kinh t - x hi xung quanh cch ranh gii ca c s t nht hai (02) km (sng, sui, ao, h v cc vc nc khc; vn quc gia, khu d tr thin nhin, khu d tr sinh quyn v cc khu bo tn thin nhin khc; h thng giao thng thy, b i n c s; cc c s sn xut, kinh doanh, dch v; cc im dn c, bnh vin, trng hc, nh th, n, cha; cc khu ngh dng, vui chi, gii tr; cc khu di tch lch s, vn ha, di sn vn ha xp hng v cc i tng kinh t - x hi khc). - Ch dn a im ang v s x nc thi ca c s v ch dn mc ch s dng nc ca ngun tip nhn theo quy nh hin hnh (trng hp c nc thi). Yu cu: Phi c t nht mt (01) bn hoc s nh km minh ha v tr a l ca c s v cc i tng xung quanh nh m t. 1.4. Cc hng mc xy dng ca c s Yu cu: a) Cc hng mc xy dng ca c s cn c chia thnh 3 nhm sau y:
3

- Nhm cc hng mc v kt cu h tng, nh: ng giao thng, bn cng, thng tin lin lc, cp in, cp nc, thot nc thi, thot nc ma, cc kt cu h tng khc; - Nhm cc hng mc phc v sn xut, kinh doanh, dch v, nh: Vn phng lm vic, nh , nh xng, nh kho, bi tp kt nguyn liu; cc hng mc lin quan khc; - Nhm cc hng mc v bo v mi trng, nh: Qun l cht thi rn thng thng v cht thi nguy hi (ni lu gi, ni trung chuyn, ni x l, ni chn lp); x l nc thi; x l kh thi; chng n, rung; chng xi l, xi mn, st, ln, trt, l t; chng ng, ngp nc; cc hng mc v bo v mi trng khc. b) Cn lit k tt c cc hng mc xy dng km theo s tng mt bng minh ha r rng cho tng hng mc trong lit k cc hng mc xy dng xong; cc hng mc ang v s xy dng km theo m t cch thc/cng ngh thi cng, khi lng thi cng, tin thi cng i vi tng hng mc. 1.5. Quy m/cng sut, thi gian hot ng ca c s - Quy m/cng sut thit k tng th, thit k cho tng giai on (nu c) ca c s. - Thi im a c s vo vn hnh/hot ng; d kin a c s vo vn hnh/hot ng (i vi c s quy nh ti im e khon 1 iu 3 Thng t ny); thi im d kin ng ca hot ng ca c s. 1.6. Cng ngh sn xut/vn hnh ca c s M t tm tt cng ngh sn xut/vn hnh ca c s km theo s minh ha, trong c ch dn c th v tr ca cc dng cht thi v/hoc v tr c th gy ra cc vn mi trng khng do cht thi (nu c). 1.7. My mc, thit b, nguyn liu, nhin liu, vt liu s dng cho hot ng sn xut/kinh doanh/dch v ca c s 1.7.1. My mc, thit b Lit k y cc loi my mc, thit b lp t v ang vn hnh; ang v s lp t (i vi c s quy nh ti im e khon 1 iu 3 Thng t ny) vi ch dn c th v: Tn gi, ni sn xut, nm sn xut, tnh trng khi a vo s dng (mi hay c, nu c th t l cn li l bao nhiu). 1.7.2. Nguyn liu, nhin liu Lit k tng loi nguyn liu, nhin liu, ha cht cn s dng vi ch dn c th v: Tn thng mi, cng thc ha hc (nu c), khi lng s dng tnh theo n v thi gian (ngy, thng, qu, nm). 1.7.3. Nhu cu v in, nc v cc vt liu khc Nu c th khi lng in, nc v cc vt liu khc cn s dng tnh theo n v thi gian (ngy, thng, qu, nm). 1.8. My mc, thit b, nguyn liu, nhin liu, vt liu s dng cho vic x l mi trng ca c s 1.8.1. My mc, thit b
4

Lit k y cc loi my mc, thit b lp t v ang vn hnh; ang v s lp t (i vi c s cha c cng trnh, bin php bo v mi trng t quy chun mi trng (nu c) v c s quy nh ti im e khon 1 iu 3 Thng t ny) vi ch dn c th v: Tn gi, ni sn xut, nm sn xut, tnh trng khi a vo s dng (mi hay c, nu c th t l cn li l bao nhiu). 1.8.2. Nguyn liu, nhin liu, vt liu Lit k tng loi nguyn liu, nhin liu, k c cc ha cht (nu c) , ang v s s dng vi ch dn c th v: Tn thng mi, cng thc ha hc (nu c), khi lng s dng tnh theo n v thi gian (ngy, thng, qu, nm). 1.8.3. Nhu cu v in, nc v cc vt liu khc Nu c th khi lng in, nc v cc vt liu khc , ang v s s dng tnh theo n v thi gian (ngy, thng, qu, nm). Yu cu: i vi Mc 1.7 v 1.8, cn c cam kt rng tt c cc loi my mc, thit b, nguyn liu, nhin liu, vt liu nu trn u khng thuc danh mc cm s dng Vit Nam theo quy nh hin hnh. 1.9. Tnh hnh thc hin cng tc bo v mi trng ca c s trong thi gian qua - Nu tm tt tnh hnh thc hin cng tc bo v mi trng ca c s t giai on chun b (gii phng mt bng) n thi im lp n bo v mi trng chi tit. - L do khng lp bo co bo co nh gi tc ng mi trng hoc n bo v mi trng trc y. - Hnh thc, mc b x pht vi phm hnh chnh v x pht khc v mi trng (nu c). - Nhng tn ti, kh khn (nu c). Yu cu: Trng hp b x pht, phi sao v nh km cc vn bn x pht vo phn ph lc ca bn n. Chng 2. M T CC NGUN CHT THI, CC VN MI TRNG KHNG LIN QUAN N CHT THI CA C S V BIN PHP QUN L/X L 2.1. Ngun cht thi rn thng thng 2.2. Ngun cht thi lng 2.3. Ngun cht thi kh 2.4. Ngun cht thi nguy hi Yu cu: i vi cc loi cht thi rn, lng v kh phi: - M t r tng ngun pht sinh cht thi km theo tnh ton c th v: Hm lng thi (nng ) ca tng thng s theo Tiu chun Vit Nam hoc Quy chun k thut v mi trng tng ng; tng lng/lu lng thi (kg,tn,m3) ca tng thng s v ca ton b ngun trong mt ngy m (24 gi), mt thng, mt qu v mt nm. - Tnh ton tng lng/lu lng thi (kg,tn,m3) ca ton b c s trong mt ngy m (24 gi), mt thng, mt qu v mt nm; trng hp c s c t 02 im thi khc nhau tr ln ra mi trng th phi tnh tng lng/lu lng thi cho tng im thi.
5

- M t quy trnh qun l, x l cht thi. - M t hnh thc x l (t x l, thu x l), cng ngh v bin php x l:

Trng hp t x l, phi m t cng ngh v bin php x l, c trng ca cht thi trc v sau x l, hiu qu x l, kt qu t c v so snh kt qu vi cc tiu chun, quy chun k thut v mi trng hin hnh. Trng hp thu x l (i vi cht thi rn, cht thi lng), phi nu r tn, a ch ca n v nhn x l thu, c hp ng chnh thc, hp ng nguyn tc (i vi cng trnh d kin s xy dng) v vic thu x l, sao v nh bn sao hp ng ny phn ph lc ca bn n.

2.5. Ngun ting n, rung - M t r tng ngun pht sinh ting n, rung. - M t bin php x l v nh gi hiu qu x l ca bin php trn c s so snh vi cc tiu chun, quy chun k thut v mi trng hin hnh. 2.6. Cc vn mi trng, vn kinh t - x hi do c s to ra khng lin quan n cht thi - M t cc vn mi trng do c s to ra (nu c), nh: Xi mn, trt, st, l, ln t; xi l b sng, b sui, b h, b bin; thay i mc nc mt, nc ngm; xm nhp mn; xm nhp phn; suy thoi cc thnh phn mi trng vt l v sinh hc; bin i a dng sinh hc, v cc vn mi trng khc khng lin quan n cht thi; gii php/bin php x l tng vn xy ra, nh gi hiu qu v mc t c ca gii php/bin php ny so vi cc quy nh hin hnh (nu c). - M t cc vn kinh t - x hi do c s to ra (nu c) lin quan n hot ng gii phng mt bng (n b/bi thng, ti nh canh, ti nh c v cc hot ng khc lin quan n vic gii phng mt bng); gii php/bin php x l tng vn xy ra, nh gi hiu qu v mc ph hp ca gii php/bin php ny so vi cc quy nh hin hnh (nu c). Yu cu: Vic trnh by, m t ca cc mc t 2.1 n 2.6 phi th hin r theo tng giai on, c th nh sau: - Giai on vn hnh/hot ng hin ti. - Giai on vn hnh/hot ng trong tng lai theo k hoch t ra (nu c). - Giai on chun b, thi cng xy dng, vn hnh/hot ng ton b (ch p dng i vi c s quy nh ti im e khon 1 iu 3 Thng t ny). - Giai on thi cng xy dng hng mc v qun l/x l mi trng v vn hnh/hot ng ton b (ch p dng i vi c s cha hon thin cng trnh, bin php bo v mi trng t quy chun k thut v mi trng); v - Giai on ng ca hot ng (nu c). Chng 3. K HOCH XY DNG, VN HNH TH NGHIM CC CNG TRNH X L CHT THI (Chng 3 ny ch p dng i vi c s cha hon thin cng trnh, bin php bo v mi trng t quy chun k thut v mi trng v c s quy nh ti im e khon 1 iu 3 Thng t ny) 3.1. K hoch xy dng
6

3.1.1. Cc cng trnh x l ton phn (t khu tip nhn cht thi u vo n khu thi cht thi ra mi trng) 3.1.1.1. Cng trnh xy dng tng th 3.1.1.2. Cng trnh xy dng theo tng giai on/m-un (nu c) 3.1.2. Cc cng trnh x l trung gian (ch x l mang tnh trung gian, sau cht thi tip tc c a n x l tip theo ti c s x l khc) nu c 3.1.2.1. Cng trnh xy dng tng th 3.1.2.2. Cng trnh xy dng theo tng giai on/m-un (nu c) Yu cu: i vi tng cng trnh cn ch r: - Tin thc hin (bt u, hon thnh). - Kinh ph d kin. - Trch nhim thc hin. 3.2. K hoch vn hnh th nghim 3.2.1. Cc cng trnh x l ton phn 3.2.1.1. Cng trnh xy dng tng th 3.2.1.2. Cng trnh xy dng theo tng giai on/m-un (nu c) 3.2.2. Cc cng trnh x l trung gian (nu c) 3.2.2.1. Cng trnh xy dng tng th 3.2.2.2. Cng trnh xy dng theo tng giai on/m-un (nu c) Yu cu: i vi mi cng trnh cn nu r cc ni dung sau y: - S ln th nghim (s ln phi m bo nh gi v tnh i din v n nh ca kt qu th nghim, nhng khng c t hn 03 ln), thi gian d kin ca tng ln th nghim. - Thng s o c, phn tch trong mi ln th nghim (phi m bo cc thng s c trng cho cht thi ca c s v c quy nh ti cc tiu chun, quy chun k thut v mi trng tng ng). - Tin thi gian thc hin. Chng 4. K HOCH QUN L MI TRNG HNG NM 4.1. K hoch qun l cht thi
Giai on ca c s Ngun pht sinh cht thi 2 Loi cht thi v tng lng/lu lng 3 Bin php qun l/x l 4 Kinh ph d kin hng nm (triu ng) 5 Thi gian thc hin Trch nhim thc hin 7

1 Chun b

Thi cng xy dng Vn hnh

ng ca hot ng

4.2. K hoch qun l cc vn mi trng khng lin quan n cht thi


Giai on ca c s Vn mi trng Bin php qun l/x l Kinh ph d kin hng nm (triu ng) 4 Trch nhim thc hin

1 Chun b Thi cng xy dng Vn hnh ng ca hot ng

4.3. K hoch ng ph s c
Giai on ca c s 1 Chun b Thi cng xy dng Vn hnh ng ca hot ng Loi s c c th xy ra Bin php ng ph Trch nhim thc hin

4.4. K hoch quan trc mi trng


Giai on ca c s Ni dung quan trc im quan trc (m s, a danh, ta ) Thng s quan trc Tn sut quan trc Kinh ph d kin Trch nhim thc hin

1 Chun b Thi cng xy dng Vn hnh ng ca hot ng

Yu cu: a) Mc 4.1, Mc 4.2, Mc 4.3 v Mc 4.4 i vi giai on chun b v giai on thi cng xy dng ch p dng i vi c s c k hoch, d kin xy dng cng trnh v c s quy nh ti im e khon 1 iu 3 Thng t ny. b) Mc 4.4: - i vi cht thi: Ch quan trc cc thng s c trng cho cht thi ca c s v c quy nh ti cc tiu chun, quy chun k thut v mi trng tng ng vi tn sut theo quy nh hin hnh v quan trc mi trng, trng hp cha c quy nh th phi quan trc t nht ba (03) thng/ln. - i vi mi trng xung quanh: Ch quan trc nhng ni cha c im quan trc ca c quan nh nc vi tn sut theo quy nh hin hnh v quan trc mi trng, trng hp cha c quy nh th phi quan trc t nht su (06) thng/ln. - Tng im quan trc phi c th hin trn bn hoc s minh ha. Chng 5. THAM VN KIN 5.1. Vn bn ca ch c s gi U ban nhn dn cp x - Nu r s v ngy ca vn bn ca ch c s gi U ban nhn dn cp x. - Nu r tng s x thuc a bn ca c s. 5.2. kin ca U ban nhn dn cp x - Nu r s v ngy ca vn bn tr li ca tng U ban nhn dn cp x. - Nu tm tt nhng kin chnh ca U ban nhn dn cp x, c bit lu n nhng kin khng tn thnh, nhng xut, nhng kin ngh ca U ban nhn dn cp x. - Trng hp U ban nhn dn cp x khng c vn bn tr li th phi nu r bng chng v vic ch c s gi vn bn cho U ban nhn dn cp x (giy bin nhn trc tip ca cp x hoc giy bin nhn ca bu in ni gi hoc bng chng khc). 5.3. kin phn hi ca ch c s - Nhn xt v tnh st thc, khch quan ca cc kin ca U ban nhn dn cp x i vi c s. - By t s phn hi, tip thu ca ch c s i vi cc kin khng tn thnh, cc xut, cc kin ngh ca U ban nhn dn cp x; trng hp khng tip thu th phi nu r l do v xut hng x l tip theo.
9

Yu cu: Cc vn bn tham vn kin, giy t l bng chng ca ch c s; vn bn tr li ca U ban nhn dn cp x, cc vn bn lin quan khc (nu c) phi c sao v nh km phn ph lc ca n, ch dn r cc bn sao ny c nh km ph lc c th no ca n. KT LUN, KIN NGH V CAM KT 1. Kt lun Phi kt lun r: - nhn dng c ht cc dng cht thi v tnh ton c ht cc loi cht thi, nhn dng v m t c ht cc vn v mi trng v x hi khng lin quan n cht thi hay cha; nu cha th nu r l do v xut hng gii quyt tip theo. - Cc loi cht thi, cc vn v mi trng do c s to ra c th c x l t yu cu quy nh hay khng; trng hp khng th nu r l do v xut hng gii quyt tip theo. - C kh nng ng ph hiu qu vi tnh trng nhim mi trng khi cc s c xy ra hay khng; nu khng th nu r l do v xut hng gii quyt tip theo. 2. Kin ngh Kin ngh vi cc cp, cc ngnh lin quan trung ng v a phng gii quyt cc vn vt qu kh nng gii quyt ca ch c s. 3. Cam kt - Cam kt thc hin nhng ni dung v bo v mi trng nu trong n bo v mi trng chi tit, c bit l cc ni dung v x l cht thi, x l cc vn mi trng, k hoch qun l mi trng. - Cam kt tun th cc quy nh ca php lut v bo v mi trng c lin quan n c s, k c cc tiu chun, quy chun k thut v mi trng. - Cam kt n b v khc phc nhim mi trng trong trng hp xy ra cc s c trong qu trnh trin khai xy dng v hot ng ca c s. PH LC Ph lc 1: Cc vn bn lin quan Ph lc 1.1. Bn sao cc vn bn php l lin quan n s hnh thnh c s Ph lc 1.2. Bn sao cc vn bn v x l vi phm v mi trng (nu c) Ph lc 1.3. Bn sao cc vn bn v tham vn kin Ph lc 1.4. Bn sao cc phiu kt qu phn tch th nghim v mi trng, hp ng x l v mi trng (nu c) Ph lc 1.5. Bn sao cc vn bn khc c lin quan (nu c) Ph lc 2: Cc hnh, nh minh ha (tr cc hnh, nh th hin trong bn n)

10

Ph lc 3 Mu vn bn ngh thm nh, ph duyt n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: ...../.. V/v thm nh v ph duyt n bo v mi trng chi tit ca(2) CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc (a danh), ngy thng nm

Knh gi: (3) (1) c a ch ti (4), xin gi n (3) nm (05) bn n bo v mi trng chi tit ca (2) Chng ti cam kt rng mi thng tin, s liu a ra ti bn n ni trn l hon ton trung thc v hon ton chu trch nhim trc php lut nu c g sai phm. Knh ngh (3) sm xem xt, thm nh v ph duyt n bo v mi trng chi tit ny. Xin trn trng cm n./..
Ni nhn: - Nh trn; - (6) - Lu

(5) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn y ca c s. (3) Tn c quan thm quyn thm nh. (4) a ch lin h theo bu in. (5) i din c thm quyn ca c quan/doanh nghip ch c s. (6) Ni nhn khc (nu c).

11

Ph lc 4 Mu ba v trang ph ba ca n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

(TN C QUAN CH QUN/ PH DUYT C S - nu c) (TN C QUAN/DOANH NGHIP CH C S)

N BO V MI TRNG CHI TIT ca (1)

C QUAN/DOANH NGHIP CH C S (*) (Ngi i din c thm quyn k, ghi h tn, ng du)

C QUAN T VN (nu c) (*) (Ngi i din c thm quyn k, ghi h tn, ng du)

Thng nm
Ghi ch: (1) Tn y , chnh xc ca c s (theo vn bn v u t ca c s). (*) Ch th hin trang ph ba.

Ph lc 5
12

Mu vn bn xin kin ca ch c s gi y ban nhn dn cp x xin kin v n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: ......../ V/v xin kin v n bo v mi trng chi tit i vi (2) CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc (a danh), ngy thng nm

Knh gi: U ban nhn dn (3) Thc hin quy nh php lut hin hnh, (1) xin gi n qu y ban ni dung tm tt ca n bo v mi trng chi tit ca (2) nghin cu v cho kin. Knh mong qu y ban sm c vn bn tr li v gi ti (1) theo a ch sau y: (a ch theo ng bu in) Phng tin lin lc ca chng ti: - S in thoi: - Hp th in t: .. - S fax (nu c): . Xin trn trng cm n./.
Ni nhn: - Nh trn; - (5) ... - Lu.

(4) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn y ca c s. (3) Tn x hoc n v hnh chnh tng ng. (4) i din c thm quyn ca c quan/doanh nghip ch c s. (5) Ni nhn khc (nu c).

TM TT NI DUNG CA N BO V MI TRNG CHI TIT


13

( km theo cng vn s ......../ ngy thng nm ca (1))

1. M T TM TT HOT NG CA C S 1.1. Ch r: V tr ti thn, x, huyn, tnh/thnh ph trc thuc trung ng c th. 1.2. Loi hnh sn xut; cng sut thit k tng th, cng sut thit k cho tng giai on (nu c) ca c s. 1.3. Thi im a c s vo vn hnh/hot ng (i vi c s quy nh ti im a, b, c, d v im khon 1 iu 3 Thng t ny). 1.4. M t mc thi cng xy dng v d kin thi im a c s vo vn hnh chnh thc (i vi c s quy nh ti im e khon 1 iu 3 Thng t ny). 2. TM TT CNG TC BO V MI TRNG CA C S 2.1. Tm tt v cc loi cht thi pht sinh v bin php x l ca c s 2.1.1. Cht thi lng 2.1.2. Cht thi kh Lu : Ch nu tng lng pht sinh ca tng loi trong mt ngy m (24 gi), bin php x l v hiu qu x l hin ti v nhng ni dung c thay i (nu c) trong thi gian ti. 2.1.3. Cht thi rn thng thng 2.1.4. Cht thi nguy hi Lu : Ch nu tng lng pht sinh ca tng loi trong mt thng (30 ngy), bin php qun l hin ti v nhng ni dung c thay i (nu c) trong thi gian ti. 2.1.5. Ting n, rung Lu : Ch dn ngun pht sinh ting n, rung km theo mc ; bin php x l v hiu qu x l hin ti v nhng ni dung c thay i (nu c) trong thi gian ti. 2.2. Cc vn nh hng n kinh t - x hi do c s to ra Lit k cc vn , ang v s to ra; lu c bit n khu gii phng mt bng (n b, ti nh canh, ti nh c); bin php i vi tng vn . 2.3. Nhng tn ti, kh khn (nu c). 3. KIN NGH V CAM KT 3.1. Kin ngh Kin ngh v nhng vn cn s h tr, gip ca U ban nhn dn cp x. 3.2. Cam kt - Cam kt thc hin nhng ni dung v x l cht thi, x l cc vn mi trng khng lin quan n cht thi, k hoch qun l mi trng. - Cam kt tun th cc quy nh ca php lut v bo v mi trng c lin quan n c s. - Cam kt n b v khc phc nhim mi trng trong trng hp xy ra cc s c trong qu trnh trin khai xy dng, hot ng ca c s./.
14

Ph lc 6 Mu vn bn ca y ban nhn dn cp x tr li ch c s
(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) UBND (1) S: ......../ V/v kin v n bo v mi trng chi tit i vi (2) CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc (a danh), ngy thng nm

Knh gi: (3) Phc p Vn bn s . ngy . thng .nm .ca (3), U ban nhn dn (1) xin c kin nh sau: 1. V vic thc hin cng tc bo v mi trng v khc phc nh hng kinh t - x hi trn a bn (1) ca (3) - C g cha ng, cha , cha tha mn so vi nhng ni dung m ch c s nu trong vn bn xin kin, nht l cc ni dung v gii phng mt bng, n b, ti nh canh, ti nh c (nu c); c chnh sa, b sung g? - C ph hp vi c im v t nhin v mi trng, vi thun phong m tc ca a phng hay khng, nu khng th biu hin c th ch no? c ph hp, tha mn v p ng c c yu cu t ra ca php lut hin hnh i vi a phng hay khng, nu khng th biu hin khu no, ch no? 2. Cc kin khc v kin ngh xut - Nhng kin khc v bo v mi trng c lin quan n c s. - Cc xut, kin ngh v bo v mi trng ti a phng c lin quan n hot ng ca c s.
Ni nhn: - Nh trn; - (5) ... - Lu.

(4) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn x hoc n v hnh chnh tng ng. (2) Tn y ca c s. (3) Tn c quan/doanh nghip ch c s. (4) Ch tch hoc Ph ch tch y ban nhn dn cp x. (5) Ni nhn khc (nu c).

15

Ph lc 10 Mu chng thc ph duyt n bo v mi trng chi tit, cp giy xc nhn ng k n bo v mi trng n gin
(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

1. Ph lc 10a
(1) chng thc: n bo v mi trng chi tit ny c ph duyt bi Quyt nh s ngy thng nm ca (2)... (a danh), ngy thng nm Th trng (1) (k, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan thng trc thm nh tng ng. (2) Th trng hoc ngi ng u c quan thm quyn thm nh tng ng.

2. Ph lc 10b
(1) chng thc: n bo v mi trng n gin ny c cp giy xc nhn ng k s ngy thng nm ca (2)... (a danh), ngy thng nm Th trng (1).. (k, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan thng trc ng k tng ng. (2) y ban nhn dn cp huyn tng ng.

16

Ph lc 11 Mu vn bn ngh xc nhn vic thc hin n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

Knh gi: (2)


(1) S:
V/v ngh kim tra, xc nhn vic thc hin n bo v mi trng chi tit

CNG HO X HI CH NGHA VIT NAM c lp - T do - Hnh phc (a danh), ngy thng nm

Chng ti l: (1), Ch c s ca c s (3) (sau y gi tt l C s), c (4) ph duyt n bo v mi trng chi tit ti Quyt nh s ngy thng nm - a im thc hin c s: - a ch lin h: - in thoi: ; Fax: ; E-mail: thc hin n bo v mi trng chi tit, gm c: 1 2 Theo quy nh ca Thng t s 01/2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin, xin gi n qu (2) h s gm: - Mt (01) bn sao quyt nh ph duyt km theo bn sao n bo v mi trng chi tit c (4) ph duyt; - Nm (05) bn bo co kt qu thc hin n bo v mi trng chi tit ca c s; - Ph lc (vi s lng bng vi s lng bn bo co kt qu thc hin n bo v mi trng chi tit) km theo bo co kt qu thc hin n bo v mi trng chi tit, bao gm cc bn sao ti liu sau (ty loi hnh c s m c th c mt s hoc tt c cc ti liu ny): + H s bn v hon cng cc cng trnh x l v bo v mi trng (trng hp cha c bn v hon cng, c th cung cp h s thit k k thut. Trng hp ch c h s thit k k thut, cn nu r thc hin ng nh h s thit k k thut hay khng. Nu c sai khc cn ch r); + Cc chng ch, chng nhn, cng nhn ca cc thit b x l mi trng ng b nhp khu hoc c thng mi ha (nu c); + Cc phiu ly mu v kt qu o c, phn tch mu vn hnh th nghim cc cng trnh x l cht thi;
17

+ Bin bn nghim thu cc cng trnh bo v mi trng hoc cc vn bn khc c lin quan n cc cng trnh, bin php bo v mi trng; + Hp ng thu gom, vn chuyn, x l cht thi rn thng thng vi n v c chc nng (i vi trng hp c s c pht sinh cht thi rn thng thng trong giai on vn hnh v khng c cng trnh x l cht thi rn thng thng); + S ng k ch ngun thi cht thi nguy hi; hp ng thu gom, vn chuyn, x l cht thi nguy hi vi n v c chc nng, km theo vn bn chng minh chc nng ca n v (i vi trng hp c s c pht sinh cht thi nguy hi trong giai on vn hnh v khng c cng trnh x l cht thi nguy hi); + Hp ng hoc bin bn tha thun v vic u ni vo h thng thu gom v x l nc thi (i vi trng hp c s nm trong khu sn xut, kinh doanh, dch v tp trung v c pht sinh nc thi trong giai on vn hnh); + Quyt nh ph duyt k hoch phng nga v ng ph s c trn du; vn bn chng nhn iu kin v phng chy cha chy cp cho c s (i vi trng hp c s thuc i tng phi c cc loi vn bn ny theo quy nh ca php lut). Chng ti xin bo m v trung thc ca cc thng tin, s liu c a ra trong cc ti liu nu trn. Nu c g sai tri, chng ti xin hon ton chu trch nhim trc php lut ca nc Cng ho x hi ch ngha Vit Nam. ngh qu (2) kim tra, xc nhn vic thc hin n bo v mi trng chi tit./.
Ni nhn:
- Nh trn; - (6) - Lu:...

(5) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn ch c s. (2) Tn c quan c trch nhim kim tra, xc nhn. (3) Tn y ca c s. (4) C quan ph duyt n bo v mi trng chi tit. (5) i din c thm quyn ca ch c s. (6) Ni nhn khc (nu c).

18

Ph lc 12 Mu bo co kt qu vic thc hin n bo v mi trng chi tit


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: /.. V/v bo co v ngh xc nhn hon thnh vic thc hin n bo v mi trng chi tit CNG HO X HI CH NGHA VIT NAM c lp T do Hnh phc (a danh), ngy thng nm

Knh gi: (2) (1) xin bo co kt qu thc hin n bo v mi trng chi tit ca (3) (hoc giai on ca (3)) theo k hoch xy dng v vn hnh th nghim c ra trong n bo v mi trng chi tit, c th nh sau: 1. V tr ca (3) : ... 2. a ch v phng tin lin h ca (1) : - a ch lin h theo bu in: - in thoi: ; Fax: ; E-mail: 3. Kt qu vn hnh th nghim 3.1. Cc cng trnh x l ton phn 3.1.1. Cng trnh xy dng tng th 3.1.2. Cng trnh xy dng theo tng giai on/m-un (nu c) 3.2. Cc cng trnh x l trung gian (nu c) 3.2.1. Cng trnh xy dng tng th 3.2.2. Cng trnh xy dng theo tng giai on/m-un (nu c)
Yu cu: 1. i vi vic th nghim x l kh thi, nc thi: - Ch dn r: Tn v a ch ca n v thc hin vic o c, ly mu, phn tch mu; phng php o c, ly mu, phn tch mu; thit b o c, ly mu, phn tch mu trong cc ln th nghim. - Kt qu th nghim ca tng cng trnh (ton phn hoc trung gian) c trnh by theo bng sau: Thng s 1 A B . Th nghim ln 2: Ngy thng nm ; Tng lng/Lu lng . A B 19 n v tnh 2 Trc khi x l 3 Sau khi x l 4 Theo QCVN 5

Th nghim ln 1: Ngy thng nm ; Tng lng/Lu lng .

. Th nghim ln 3: Ngy thng nm ; Tng lng/Lu lng . A B . 2. i vi vic th nghim x l cht thi rn thng thng, cht thi nguy hi: - Trng hp t x l: M t quy trnh qun l (thu gom, vn chuyn, lu gi, x l); bin php, phng tin, tin nghi s dng trong tng cng on ca quy trnh qun l. - Trng hp thu x l: M t cc bin php, phng tin, tin nghi thu gom v lu gi tm thi; tn v a ch ca n v x l thu; bin php, phng tin thu gom v vn chuyn ca n v x l thu; tn sut thu gom ca n v x l thu.

4. Nhng thay i so vi k hoch ra trong n bo v mi trng chi tit (nu c) 5. nh gi kt qu th nghim - nh gi v tin cy, mc t c v tnh n nh ca kt qu th nghim x l kh thi, x l nc thi. - nh gi v mc tun th quy nh ca cc bin php qun l cht thi rn thng thng v cht thi nguy hi. 6. H s km theo bo co Chng ti xin gi nhng h s, ti liu c lin quan c ng thnh tp km theo bo co ny. 7. Cam kt v ngh Chng ti cam kt rng nhng thng tin, s liu nu trn l ng s thc; nu c g sai tri, s phi hon ton chu trch nhim trc php lut. ngh (2) kim tra v xc nhn chng ti a cng trnh vo vn hnh chnh thc./.
Ni nhn: - Nh trn; - (5) - Lu:

(4) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn c quan c trch nhim cp giy xc nhn hon thnh. (3) Tn y ca c s. (4) i din c thm quyn ca c quan/doanh nghip ch c s. (5) Ni nhn khc (nu c).

20

Ph lc 13 Mu bo co kt qu vic thc hin n bo v mi trng chi tit (i vi c s quy nh ti im e khon 1 iu 3 Thng t ny v khai thc khong sn)
(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: /.. V/v bo co kt qu hon thnh hng mc cng trnh qun l, x l cht thi v cng trnh lin quan n bo v mi trng (a danh), ngy thng nm CNG HO X HI CH NGHA VIT NAM c lp T do Hnh phc

Knh gi: (2) (1) xin bo co kt qu hon thnh xy dng cc cng trnh qun l, x l cht thi v cng trnh c lin quan n bo v mi trng phc v cho giai on khai thc khong sn ca (3) theo k hoch v ni dung c ra trong n bo v mi trng chi tit, c th nh sau: 1. V tr ca (3) : ... 2. a ch v phng tin lin h ca (1) : - a ch lin h theo bu in: - in thoi: ; Fax: ; E-mail: 3. Hng mc cng trnh xy dng xong
TT 1 1 2 3 4 5 6 Hng mc 2 Cng trnh qun l, x l cht thi Cng trnh x l nc thi Cng trnh x l kh thi Ni lu gi, trung chuyn cht thi rn thng thng Ni lu gi, trung chuyn cht thi nguy hi Cng trnh chng n, rung Cng trnh khc .. .. Cng trnh c lin quan n bo v mi trng ng giao thng ni b m ng giao thng ngoi m do c s t xy dng H thng thot nc m H thng bi thi trong, bi thi ngoi Kho thuc n Kho ha cht H thng dung dch khoan (trong khai thc du kh, nc ngm) M t 3

1 2 3 4 5 6 7

21

8 9 10

H thng chng phun, chng pht (trong khai thc du kh) H thng ng ph s c trn du (trong khai thc du kh) Hng mc khc ..

Yu cu: Phi c s tng mt bng ch dn v tr tng hng mc cng trnh vi ch gii r rng.

4. H s km theo bo co Chng ti xin gi nhng h s, ti liu c lin quan c ng thnh tp km theo bo co ny. 5. Cam kt v ngh Chng ti cam kt rng nhng thng tin, s liu nu trn l ng s thc; nu c g sai tri, s phi hon ton chu trch nhim trc php lut. ngh (2) kim tra v xc nhn chng ti a cng trnh vo hot ng./. (4)
Ni nhn: - Nh trn; - (5) - Lu:

(K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn c quan c trch nhim cp giy xc nhn hon thnh. (3) Tn y ca c s. (4) i din c thm quyn ca c quan/doanh nghip ch c s. (5) Ni nhn khc (nu c).

22

Ph lc 14 Mu bo co kt qu vic thc hin n bo v mi trng chi tit (i vi c s quy nh ti im e khon 1 iu 3 Thng t ny c h cha nc)
(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: /.. V/v bo co v vic thu dn lng h v xy dng cc bin php bo v mi trng (a danh), ngy thng nm CNG HO X HI CH NGHA VIT NAM c lp T do Hnh phc

Knh gi: (2) (1) xin bo co kt qu hon thnh vic thu dn lng h v xy dng bin php bo v mi trng (nu c) ca (3) theo k hoch v ni dung c ra trong n bo v mi trng chi tit, c th nh sau: 1. V tr ca (3) : ... 2. a ch v phng tin lin h ca (1) : - a ch lin h theo bu in: - in thoi: ; Fax: ; E-mail: 3. Kt qu thu dn lng h
TT Hng mc thu dn 1 1 2 3 4 5 6 7 2 Thm thc vt (din tch, sinh khi, cy c g) Nh M m Cng trnh vn ha, tn gio, tn ngng (tn c th tng cng trnh) Khong sn khai thc tn thu (tn c th tng loi) Cng trnh sn xut, kinh doanh, dch v (tn c th tng cng trnh) Hng mc khc n v tnh 3 Khi lng, s lng 4 Hnh thc, cch thc tin hnh 5 Mc hon thnh so vi k hoch hoc yu cu t ra 6 Ghi ch 7

4. Nhng hng mc khng th thu dn c (nu c) - Tn hng mc khng th thu dn c - L do khng th thu dn c - Bin php x l hoc kin ngh bin php x l 5. Cc bin php bo v mi trng (nu c) 6. H s km theo bo co
23

Chng ti xin gi nhng h s, ti liu c lin quan c ng thnh tp km theo bo co ny. 7. Cam kt v ngh Chng ti cam kt rng nhng thng tin, s liu nu trn l ng s thc; nu c g sai tri, s phi hon ton chu trch nhim trc php lut. ngh (2) kim tra v xc nhn chng ti a cng trnh h cha vo tch nc./. (4)
Ni nhn: - Nh trn; - (5) - Lu:

(K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn c quan c trch nhim cp giy xc nhn hon thnh. (3) Tn y ca c s. (4) i din c thm quyn ca c quan/doanh nghip ch c s. (5) Ni nhn khc (nu c).

24

Ph lc 18 S quy trnh lp, ng k v xc nhn ng k n bo v mi trng n gin


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)
Lp

Ch c s

H s n bo v mi trng n gin
Np

H s cha y

Vn phng tip nhn H s ca y ban nhn dn cp huyn


H s y

Np li xc nhn sau khi chnh sa

U ban nhn dn cp huyn (C quan thng trc ng k)

Ni dung n khng ng quy nh

T chc xem xt ni dung n


Ni dung n ng quy nh

Kim tra thc t (nu cn); ly kin chuyn gia (nu cn)
Thng qua khng cn chnh sa n

Khng thng qua n


Chnh sa n

Thng bo kt qu xem xt

Thng qua cn chnh sa n

Cp Giy xc nhn (y ban nhn dn cp huyn)

25

Ph lc 19a Cu trc v ni dung ca n bo v mi trng n gin i vi c s c d n u t


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

MC LC DANH MC T NG VIT TT M U - C s c thnh lp theo quyt nh ca ai/cp no, s v ngy ca vn bn hay quyt nh thnh lp; s v ngy ca vn bn ng k u t (nu c); s v ngy ca giy chng nhn u t (nu c); cc thng tin lin quan khc (sao v nh km cc vn bn phn ph lc ca n). - Vic thnh lp c s c ph hp vi cc quy hoch lin quan c ph duyt hay khng (quy hoch s dng t, quy hoch pht trin kinh t - x hi, quy hoch pht trin ngnh, cc quy hoch lin quan khc), c ph hp vi ch trng pht trin kinh t x hi ti a bn hay khng. - Trng hp a im ca c s t ti khu sn xut, kinh doanh, dch v tp trung th phi nu r tn ca khu/cm, s v ngy ca vn bn chp thun ca Ban qun l khu/cm (sao v nh km vn bn phn ph lc ca n). - Nu r tnh trng hin ti ca c s (thuc loi no theo quy nh ti khon 1 iu 15 ca Thng t ny). Chng 1. M T TM TT C S V TNH HNH THC HIN CNG TC BO V MI TRNG QUA CA C S 1.1. Tn ca c s Nu y , chnh xc tn gi hin hnh ca c s (thng nht vi tn ghi trang ba v trang ph ba ca n bo v mi trng ny). 1.2. Ch c s Nu y h, tn v chc danh ca ch c s km theo ch dn v a ch lin h, phng tin lin lc (in thoi, fax, hm th in t). 1.3. V tr a l ca c s - M t v tr a l ca c s: Nu c th v tr thuc a bn ca n v hnh chnh t cp thn v/hoc x tr ln; trng hp c s nm trong khu sn xut, kinh doanh, dch v tp trung th phi ch r tn khu/cm ny trc khi nu a danh hnh chnh; ta cc im khng ch v tr ca c s (nu c). - M t cc i tng t nhin, kinh t - x hi xung quanh cch ranh gii ca c s t nht mt (01) km (sng, sui, ao, h v cc vc nc khc; vn quc gia, khu d tr thin nhin, khu d tr sinh quyn v cc khu bo tn thin nhin khc; h thng giao thng thy, b i n c s; cc c s sn xut, kinh doanh, dch v; cc im dn c, bnh vin, trng hc, nh th, n, cha; cc khu ngh dng, vui chi, gii tr; cc khu di tch lch s, vn ha, di sn vn ha xp hng v cc i tng kinh t - x hi khc).
26

Yu cu: Phi c t nht mt (01) bn hoc s nh km minh ha v tr a l ca c s v cc i tng xung quanh nh m t. 1.4. Quy m/cng sut, thi gian hot ng ca c s - Quy m/cng sut. - Thi im a c s vo vn hnh/hot ng; d kin a c s vo vn hnh/hot ng (i vi c s quy nh ti im khon 1 iu 15 Thng t ny). 1.5. Cng ngh sn xut/vn hnh ca c s M t tm tt cng ngh sn xut/vn hnh ca c s km theo s minh ha, trong c ch dn c th v tr ca cc dng cht thi v/hoc v tr c th gy ra cc vn mi trng khng do cht thi (nu c). 1.6. My mc, thit b Lit k y cc loi my mc, thit b lp t v ang vn hnh; ang v s lp t (i vi c s quy nh ti im khon 1 iu 15 Thng t ny) vi ch dn c th v: Tn gi, ni sn xut, nm sn xut, tnh trng khi a vo s dng (mi hay c, nu c th t l cn li l bao nhiu). 1.7. Nguyn liu, nhin liu, vt liu Lit k tng loi nguyn liu, nhin liu, ha cht cn s dng vi ch dn c th v: Tn thng mi, cng thc ha hc (nu c), khi lng s dng tnh theo n v thi gian (ngy, thng, qu, nm). Nu c th khi lng in, nc v cc vt liu khc cn s dng tnh theo n v thi gian (ngy, thng, qu, nm). 1.8. Tnh hnh thc hin cng tc bo v mi trng ca c s trong thi gian qua - Nu tm tt tnh hnh thc hin cng tc bo v mi trng ca c s t giai on chun b (gii phng mt bng) n thi im lp n bo v mi trng n gin. - L do khng lp bn ng k t tiu chun mi trng, bn cam kt bo v mi trng hoc n bo v mi trng trc y. - Hnh thc, mc b x pht vi phm hnh chnh v x pht khc v mi trng (nu c). - Nhng tn ti, kh khn (nu c). Yu cu: Trng hp b x pht, phi sao v nh km cc vn bn x pht vo phn ph lc ca bn n. Chng 2. M T CC NGUN CHT THI, CC VN MI TRNG KHNG LIN QUAN N CHT THI CA C S V BIN PHP QUN L/X L 2.1. Ngun cht thi rn thng thng 2.2. Ngun cht thi lng 2.3. Ngun cht thi kh 2.4. Ngun cht thi nguy hi
27

Yu cu: i vi cc loi cht thi rn, lng v kh phi: - M t r tng ngun pht sinh cht thi km theo tnh ton c th v: Hm lng thi (nng ) ca tng thng s theo Tiu chun mi trng hoc quy chun k thut v mi trng tng ng; tng lng/lu lng thi (kg,tn,m3) ca tng thng s v ca ton b ngun trong mt ngy m (24 gi), mt thng, mt qu v mt nm. - Tnh ton tng lng/lu lng thi (kg,tn, m3) ca ton b c s trong mt ngy m (24 gi), mt thng, mt qu v mt nm; trng hp c s c t 02 im thi khc nhau tr ln ra mi trng th phi tnh tng lng/lu lng thi cho tng im thi. - M t quy trnh qun l, x l cht thi. - M t hnh thc x l (t x l, thu x l), cng ngh v bin php x l:

Trng hp t x l, phi m t cng ngh v bin php x l, c trng ca cht thi trc v sau x l, hiu qu x l, kt qu t c v so snh kt qu vi cc tiu chun, quy chun k thut v mi trng hin hnh. Trng hp thu x l (i vi cht thi rn, cht thi lng), phi nu r tn, a ch ca n v nhn x l thu, c hp ng chnh thc, hp ng nguyn tc (i vi cng trnh d kin s xy dng) v vic thu x l, sao v nh bn sao hp ng ny phn ph lc ca bn n. - M t r tng ngun pht sinh ting n, rung.

2.5. Ngun ting n, rung - M t bin php x l v nh gi hiu qu x l ca bin php trn c s so snh vi cc tiu chun, quy chun k thut v mi trng hin hnh. 2.6. Cc vn mi trng, vn kinh t - x hi do c s to ta khng lin quan n cht thi M t cc vn mi trng do c s to ra (nu c), nh: Xi mn, trt, st, l, ln t; xi l b sng, b sui, b h, b bin; thay i mc nc mt, nc ngm; xm nhp mn; xm nhp phn; suy thoi cc thnh phn mi trng vt l v sinh hc; bin i a dng sinh hc v cc vn mi trng khc khng lin quan n cht thi; gii php/bin php x l tng vn xy ra, nh gi hiu qu v mc t c ca gii php/bin php ny so vi cc quy nh hin hnh (nu c). Yu cu: Vic trnh by, m t ca cc mc t 2.1 n 2.6 phi th hin r theo tng giai on, c th nh sau: - Giai on vn hnh/hot ng hin ti; - Giai on vn hnh/hot ng trong tng lai theo k hoch t ra (nu c); - Giai on chun b, thi cng xy dng, vn hnh/hot ng ton b (ch p dng i vi c s quy nh ti im khon 1 iu 15 Thng t ny); - Giai on thi cng xy dng cc bin php bo v mi trng,vn hnh/hot ng ton b (ch p dng i vi c s cha hon thnh cng trnh, bin php bo v mi trng t quy chun k thut v mi trng). Chng 3. K HOCH QUN L MI TRNG HNG NM 3.1. K hoch qun l cht thi
28

Giai on ca c s

Ngun pht sinh cht thi 2

Loi cht thi v tng lng/lu lng 3

Bin php qun l/x l 4

1 Chun b

Kinh ph Thi gian d kin thc hin hng nm (triu ng) 5 6

Trch nhim thc hin 7

Thi cng xy dng

Vn hnh

3.2. K hoch qun l cc vn mi trng khng lin quan n cht thi


Giai on ca c s Vn mi trng Bin php qun l/x l Kinh ph d kin hng nm (triu ng) 4 Trch nhim thc hin

1 Chun b Thi cng xy dng Vn hnh

3.3. K hoch ng ph s c
Giai on ca c s Loi s c c th xy ra Bin php ng ph Trch nhim thc hin

1 Chun b Thi cng xy dng Vn hnh

3.4. K hoch quan trc mi trng


Giai on ca c s Ni dung quan trc im quan trc (m s, a danh, ta ) Thng s quan trc Tn sut Kinh ph Trch nhim quan d kin thc hin trc

29

1 Chun b Thi cng xy dng Vn hnh

Yu cu: a) Mc 3.1, Mc 3.2, Mc 3.3 v Mc 3.4 Giai on chun b, thi cng xy dng ch p dng i vi c s c k hoch, d kin xy dng cng trnh v c s quy nh ti im khon 1 iu 15 Thng t ny. b) Mc 3.4: - i vi cht thi: Ch quan trc cc thng s c trng cho cht thi ca c s v c quy nh ti cc tiu chun, quy chun k thut tng ng vi tn sut theo quy nh hin hnh v quan trc mi trng, trng hp cha c quy nh th phi quan trc t nht ba (03) thng/ln. - i vi mi trng xung quanh: Ch quan trc nhng ni cha c im quan trc ca c quan nh nc vi tn sut theo quy nh hin hnh v quan trc mi trng, trng hp cha c quy nh th phi quan trc t nht su (06) thng/ln. - Tng im quan trc phi c th hin trn bn hoc s minh ha. KT LUN, KIN NGH V CAM KT 1. Kt lun Phi kt lun r: - nhn dng c ht cc dng cht thi v tnh ton c ht cc loi cht thi, nhn dng v m t c ht cc vn v mi trng v x hi khng lin quan n cht thi hay cha; nu cha th nu r l do v xut hng gii quyt tip theo. - Cc loi cht thi, cc vn v mi trng v x hi do c s to ra c th c x l t yu cu quy nh hay khng; trng hp khng th nu r l do v xut hng gii quyt tip theo. - C kh nng ng ph hiu qu vi tnh trng nhim mi trng khi cc s c xy ra hay khng; nu khng th nu r l do v xut hng gii quyt tip theo. 2. Kin ngh Kin ngh vi cc cp, cc ngnh lin quan trung ng v a phng gii quyt cc vn vt qu kh nng gii quyt ca ch c s. 3. Cam kt - Cam kt thc hin nhng ni dung v bo v mi trng nu trong n, c bit l cc ni dung v x l cht thi, x l cc vn mi trng, k hoch qun l mi trng. - Cam kt tun th cc quy nh ca php lut v bo v mi trng c lin quan n c s, k c cc tiu chun, quy chun k thut v mi trng. - Cam kt n b v khc phc nhim mi trng trong trng hp xy ra cc s c trong qu trnh trin khai xy dng v hot ng ca c s.
30

PH LC Ph lc 1: Cc vn bn lin quan Ph lc 1.1. Bn sao cc vn bn php l lin quan n s hnh thnh c s Ph lc 1.2. Bn sao cc vn bn v x l vi phm v mi trng (nu c) Ph lc 1.3. Bn sao cc phiu kt qu phn tch th nghim v mi trng, hp ng x l v mi trng (nu c) Ph lc 1.4. Bn sao cc vn bn khc c lin quan (nu c) Ph lc 2. Cc hnh, nh minh ha (tr cc hnh, nh th hin trong bn n) Yu cu: Tng vn bn, hnh, nh trong ph lc phi c xp theo th t r rng vi m s c th v u phi c dn chiu phn ni dung tng ng ca bn n.

31

Ph lc 19b Cu trc v ni dung ca n bo v mi trng n gin i vi c s khng c d n u t v c pht sinh cht thi sn xut
(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

MC LC M U - C s c thnh lp trn c s giy php kinh doanh/ng k kinh doanh no, s v ngy ca vn bn (sao v nh km vn bn phn ph lc). - Nu r tnh trng hin ti ca c s (thuc loi no theo quy nh ti khon 1 iu 15 Thng t ny). Chng 1. M T TM TT C S 1.1. Tn ca c s Nu y , chnh xc tn gi hin hnh ca c s 1.2. Ch c s Nu y h, tn v chc danh ca ch c s km theo ch dn v a ch lin h, phng tin lin lc (in thoi, fax, hm th in t). 1.3. V tr a l ca c s Nu c th v tr thuc a bn ca n v hnh chnh t cp thn v/hoc x tr ln. 1.4. Quy m/cng sut, thi gian hot ng ca c s - Quy m/cng sut. - Thi im a c s vo vn hnh/hot ng; d kin a c s vo vn hnh/hot ng (i vi c s quy nh ti im khon 1 iu 15 Thng t ny). Chng 2. NGUN CHT THI V BIN PHP QUN L/X L 2.1. Ngun cht thi rn thng thng 2.2. Ngun cht thi lng 2.3. Ngun cht thi kh 2.4. Ngun cht thi nguy hi (nu c) Yu cu: i vi cc loi cht thi rn, lng v kh: Lit k ngun pht sinh cht thi, tng lng/lu lng thi (kg,tn,m3) ca tng ngun v ca c c s trong mt ngy m (24 gi); bin php qun l, x l. 2.5. Ngun ting n, rung Lit k cc ngun pht sinh ting n, rung, mc ; bin php x l. KT LUN, KIN NGH V CAM KT 1. Kt lun

32

- Cc vn c lin quan n cht thi, cc vn khng lin quan n cht thi c nghim trng khng, c th ch ng x l c khng? trng hp khng th nu r l do v xut hng gii quyt. - C kh nng gii quyt cc vn v cht thi v cc vn mi trng khc khng; nu khng th nu r l do v xut hng gii quyt. 2. Kin ngh Kin ngh vi cc cp, cc ngnh lin quan a phng gii quyt cc vn vt qu kh nng gii quyt ca ch c s. 3. Cam kt - Cam kt thc hin nhng ni dung v bo v mi trng nu trong n bo v mi trng n gin, c bit l cc ni dung v x l cht thi. - Cam kt tun th cc quy nh ca php lut v bo v mi trng c lin quan n c s. - Cam kt n b v khc phc nhim mi trng trong trng hp xy ra cc s c trong qu trnh trin khai xy dng v hot ng ca c s. PH LC - Cc vn bn lin quan. - Cc hnh v, hnh nh (nu c).

33

Ph lc 20 Mu vn bn ngh xc nhn ng k n bo v mi trng n gin


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin) (1) S: ...../.. V/v xc nhn ng k n bo v mi trng n gin ca (2) CNG HA X HI CH NGHA VIT NAM c lp - T do - Hnh phc (a danh), ngy thng nm

Knh gi: y ban nhn dn (3) (1) c a ch ti (4), xin gi n y ban nhn dn (3) nm (05) bn n bo v mi trng n gin ca (2) Chng ti cam kt rng mi thng tin, s liu a ra ti bn n ni trn l hon ton trung thc v hon ton chu trch nhim trc php lut nu c g sai phm. Knh ngh qu y ban sm xem xt v cp giy xc nhn ng k n bo v mi trng n gin ny. Xin trn trng cm n./.
Ni nhn: - Nh trn; - (6) - Lu

(5) (K, ghi h tn, chc danh, ng du)

Ghi ch: (1) Tn c quan/doanh nghip ch c s. (2) Tn y ca c s. (3) Tn n v hnh chnh cp huyn. (4) a ch lin h theo bu in (5) i din c thm quyn ca c quan/doanh nghip ch c s. (6) Ni nhn khc (nu c).

34

Ph lc 21 Mu ba v trang ph ba ca n bo v mi trng n gin


(Ban hnh km theo Thng t s 01 /2012/TT-BTNMT ngy 16 thng 3 nm 2012 ca B trng B Ti nguyn v Mi trng quy nh v lp, thm nh, ph duyt v kim tra, xc nhn vic thc hin n bo v mi trng chi tit; lp v ng k n bo v mi trng n gin)

(TN C QUAN CH QUN/ PH DUYT C S - nu c) (TN C QUAN/DOANH NGHIP CH C S)

N BO V MI TRNG N GIN ca (1)

C QUAN/DOANH NGHIP CH C S (*) (Ngi i din c thm quyn k, ghi h tn, ng du)

C QUAN T VN (nu c) (*) (Ngi i din c thm quyn k, ghi h tn, ng du)

Thng nm
Ghi ch: (1) Tn y , chnh xc ca c s (theo vn bn v u t ca c s). (*) Ch th hin trang ph ba.

35

You might also like