BOROUGH OF POOLE

HAMBLETON DISTRICT COUNCIL

NOTIFICATION OF COOLING TOWERS

AND EVAPORATIVE CONDENSERS REGULATIONS 1992

1

Address where the alterations are being carried out - continue overleaf if necessary

Name of Premises

Address

2

Person(s) in control of premises – please continue overleaf if necessary

Name of person

Company name

Address

Telephone Number

NB - This information is required to enable access to be gained at all times to a notifiable device.

3

How many cooling towers or evaporative condensers are at the address shown in box 1?

4

Please give details, including location, of the amendments/alterations for each piece of equipment you are intending to carry out and the date of completion of these works. If you are sending a plan of the alterations please state this here. Please continue overleaf if necessary.

Declarations

Signed by

PositionDate

Please indicate if you require a receipt YES/NO

Acknowledgement tear off - for Local Authority Use

THE NOTIFICATION OF COOLING TOWERS AND EVAPORATIVE CONDENSERS REGULATIONS

To

Name of person(s) in control

Address

Date of registration

Number of cooling towers registered

Reference number in case of query

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