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11

Arab Republic Egypt

The Cabinet of Ministers
)Egyptian Environmental Affairs Agency (EEAA

)(
)Environmental Screening Form (A

) (General Information
.1 ______________________________________________
:
((Project title
.2 ) :---______________________ -
(
))Residential, commercial, Tourstic, Industrial, others

.3 ) (:
)(Project developer/applicant
) ____________________________________
(:
)Name of owner & contact
(person
________________________________________________
:
________________________________________________
)(Address
: :
_____________________
_____________________
)(.Fax No
)(.Telephone No
.4
:
(.Estimated capital investment/ L.E
___________________________________________________________
_____________________________________
.5 :
)(Concerned licensing authority
.6 ) -(________________________________ :
)New project or extension of existing

(project
.7 :
)(Project phases and expected starting date

:
)(Construction
:
)(Operation
:
)Future

_____________________________________________
_____________________________________________
_____________________________________________

12

(expansion

13

.( .. - - - ) : .8
(Brief project description: Production capacity- Raw materials- Sources of Energy)

___________________________________________________________
___________________________________________________________
___________________________________________________________
: .9
(Project site location)
:
(Address)
2
( )
(Total project area/ M2)
: .10
(Any additional information)
___________________________________________________________
___________________________________________________________
___________________________________________________________

Certification

.
I bereby certify that the information given is accurate and true to the best of my
knowledge, and in case of any consequent changes prompt notification will be
made to the EEAA.

:
_________________________________________

Certified by

: /
_________________________________________ .LD No./passport No
:
Reference
_________________________________________
:
Date
_________________________________________

14

 - 2
/ .

.
""
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) (2
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2-1 :

150 .
.
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25 )
(.
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100 / )
( 50 / .
.
1500 .
.
200
.



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.
.

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.
100 / ) ( 500 /
.
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16

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.
""
"" 30 .


.

17

Arab Republic Egypt

The Cabinet of Ministers
)Egyptian Environmental Affairs Agency (EEAA

)(
)Environmental Screening Form (B
.

) (General Information
.1 ______________________________________________
:
((Project title
.2 ) :---______________________ -
(
))Residential, commercial, Tourstic, Industrial, others) (Type of project

.3 ) (
)(Investor/ applicant
) ____________________________________
(:
)(Project Developer or applicant

________________________________________________

:
)(reference
________________________________________________
:
________________________________________________
)(Address
: :
_____________________
_____________________
)(.Fax No
)(.Telephone No


Information to be completed by the EEAA officials

:
/
/ :
Date of application

/
Receivale Date

:
.Serial No

18

_____________________________
____

) (

)(Estimated Capital Investment, L.E

_______________________________

_____

(Concerned Licensing Authority & Address
___________________________________________________________
__________
__________________________________

)/(
)(New/ Extension

)(Project phases and expected starting dates

_____________________________
:
)(Construction
_____________________________
:
)(Operation
_____________________________
:
)(Future Extension
.4

)(Brief Project description

_____________________________
)(Project basic features & Production Capacity
___________________________________________________________
___________________________________________________________

____________________________________________
)(Objectives
___________________________________________________________
___________________________________________________________

_____________________________________________
)(Need for justification
_________________________________________________________
_________________________________________________________

____________________________________________
)(Basic components
_________________________________________________________
_________________________________________________________
19

_________________________________________________________

20

(
Technological systems. Accompanied as much as possible with layout and
Operational charts and diagrams showing inputs & outputs (including wastes)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
.5
(Alternatives Considered)
___________________________________
(Sites)
___________________________________ (Technologies)

___________________________________
___________________________________

(Designs)
)
(Materials
( )

(Are there available studies of similar projects: indicate source)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Project location and site) .6
___________________________________

(Address)
___________________________________________________________
2

___________________________________
(Total Area, m2)

(
(Please attach a detailed map with a suitable scale to indicate clearly the site,
transportation routes and pipelines, its boundaries and neibouring uses).

21

 .7
)(A brief description of the construction phases and basic construction methods

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

)
(.
(Inputs during construction and operation).
(In case of industrial projects, raw materials & for other projects, state kind of
resources).

- 1
Inputs of water, energy, and manpower, see table 1

Inputs

Construction phase

-
Water-sanitary

-
Water-Process

-
Water- other use

-
Energy/ electricity

/ )
(
)Energy/fuel (liquid,Solid, gas

/
Energy/ renewable sources

22

Operation phase


Manpower

Others

: 1

Inputs during construction and operation phases

.7
Outputs during construction and operation phases

2 ..( ) ( ) :
End products (industrial project): or other outputs (all projects, see table 2)

Operation phase

Construction phase

Type of output

Emissions, discharges
and wastes

Sulphur dioxide

Air

Particular matter

Air

Smoke

Air

Odour

Air

Noise

Air

Others

23

Air


Sewage

Water

Domestic waste

.
Solid waste

Industrial waste

Hazardous waste

Solid waste

Solid waste

:2
Outputs during construction and operation

) : .8
.( ..
Other information deemed important particularly with regard to safeguarding
personnel and environment e.g. safety and fire fighting facilities.

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

24

( ) (
)Brief description of the environment (Baseline information

*
General area description and most important features as

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

)(Present infrastructure and services

____________________________
:
)(Water
_
____________________________
:
)(Electricity
_
____________________________
:
)(Sewage
_
____________________________
_
:
)(Solid waste disposal

____________________________

)(Hospital
_
:

Fragile or sensitive ecosystems (critical or high valued ecosystems) that are

present

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

________________________________
)(Description of archeological & historical areas

___________________________________________________________
___________________________________________________________

25


________________________________
)(Description of protected areas

___________________________________________________________
___________________________________________________________
_____________________________
)(Description of recreational & touristic areas

- )(Preliminary analysis of impacts

-1 ) (
)Air Quality (Potential effects on air quality

_________________________________________
_
:
_________________________________________
)(Construction phase
_
_________________________________________
_
:
(Operation
)phase
_________________________________________
_
_________________________________________ :
)(Site
_
_________________________________________
_
_________________________________________
_

(Neighboring
)area
_________________________________________
_
_________________________________________
_
:
(Tran
)boundary
_________________________________________
_

26

 -2
.( ... )
Clarify whether projects or sites that are considered sensitive areas exist nearby
the project sites (as hospitals, schools, residential areas etc.)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Water Quality -3

(Will the activity cause a significant change on the water availability, use,
hydrology, drainage, temperature or quality?).

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

27

( )
(Are there existing hazard probabilities- explain the type, quantity and impact)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Will the activity affect surface water use?)

_______________________________________________
: _______________________________________________ (Fisheries)
_______________________________________________
: _______________________________________________ (Tourism and recreation)
_______________________________________________
: _______________________________________________ (Other activities)
Soil Quality -4

(Would the activity provoke a significant change on land use, landscape, fertility,
vegetation cover, biodiversity or quality?)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
-5
Please identify the impact of changes of soil quality on different activities

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
28

___________________________________________________________
___________________________________________________________
-6
(Please explain if there are any other potential or significant impacts resulting
from this activity)

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Mitigating measures)

(Air emissions) -1
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

29

(Waste water)

-2
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Solid and hazardous waste) -3
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Other mitigating measures) -4
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

30

 -
(Inter-institutional and public involvement)

(Is other any contact with public authorities or others concerning the project)

___________________________________________________________
___________________________________________________________
___________________________________________________________

Certification -
.
.
..
I hereby certify that the information given is accurate and true to the best of my
knowledge, and in case of any consequent changes, prompt notification will be
made to EEAA.

______________________________________

(Certified by)
______________________________________ /
:

(.L.D. No./ passport No)

______________________________________

(Reference)
_______________________

:
(Date)

31

-3

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