• 1. The name, address and telephone number of the applicant.

• 2. The name, position title, telephone number, facsimile number and E-mail address of a contact person.

• 3. The name, mailing address and geographic location of the mine.

• 4. A general description of the mining operation with details of the parts of the operation for which the application is made.

• 5. A site plan showing the location of the main mining and milling facilities, the effluent treatment facilities and all the final discharge points.

• 6. All available pH data and data related to the monthly mean concentrations of the deleterious substances set out in column 1 of Schedule 4 in the effluent for which the application is made for the one-year period immediately preceding the date of application.

• 7. The effluent flow rate at each final discharge point.

• 8. The available results of all acute lethality tests related to the effluent for which the application is made for the one-year period immediately preceding the date of application.

• 9. Plans, specifications and other information on the design and capability of the effluent treatment process in place at the mine on the date of application.

• 10. Based on the best available information at the time of application, a description of the facilities and procedures that are necessary to produce a non-acutely lethal effluent that complies with the authorized limits of the substances set out in column 1 of Schedule 4.

• 11. A proposed schedule for the construction of the facilities and implementation of the procedures.

• 12. The details of any effluent monitoring results related to fish, fish habitat or the human use of fish that are known to the operator.

• 13. A signed statement indicating whether there is a law in the jurisdiction where the mine is located, and the identification of that law, that requires the mine to produce

  • (a) a non-acutely lethal effluent;

  • (b) an effluent containing a deleterious substance in a concentration that is equal to or less than the limits set out in Schedule 4; or

  • (c) an effluent with a pH equal to or greater than 6.0 but not greater than 9.5.

• 14. Any further information that is required to support the application.

I certify that the information provided under Part 1 of Schedule 7 to the Metal Mining Effluent Regulations was prepared by persons with sufficient knowledge to evaluate the information. I further certify, based on my reasonable inquiry of the persons responsible for making the determination, that the information submitted is true, accurate and complete.

Date:	Signature :	{ (operator, owner or their authorized representative) }
		{ (Position title) }