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Model Pollution Prevention Plan

1.0 Facility Information

Fill in the table below with your facility information. For facilities subject to a Pollution Prevention (P2) Planning Notice, this information is required in the Declaration of Preparation, Information on the Person or Class of Persons Subject to the Notice.

Table 1: Summary of Facility Information

Persons or Class of Persons Subject to the P2 Planning Notice:
Name:

Facility Subject to the P2 Planning Notice:
Name:
Street Address of Facility:
City: Province/Territory: Postal Code:

Contact Information at Facility:
Telephone Number:
Email (if available):
Mailing Address (if different from Street Address):

Contact Information of Persons with Signing Authority for the Declarations:
Name:
Position at Facility:
Telephone: Fax:
Email:

Accountable Manager for the P2 Plan:
Name:
Position at Facility:
Telephone: Fax:
Email:

Technical Contact:
Name:
Position at Facility:
Telephone: Fax:
Email:
North American Industry Classification System (NAICS) 2002:
National Pollutants Release Inventory Identification Number (NPRI ID):

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