This is an HTML version of an attachment to the Freedom of Information request 'EPR Surrender Application and Supporting Documents EPR/XP3434WY/S002 and EPR/BV0210IM/S002'.

Form EPA: Application for an environmental permit – Part A about you
Application for an environmental permit 
Part A – About you  
You will need to fill in this part A if you are applying 
tick the box in section 4 of F1 or F3 and enclose a letter telling 
for a new permit, applying to change an existing 
us that you have told the Secretary of State. We will not 
permit or surrender your permit, or want to transfer 
include the information in the public register unless directed 
an existing permit to yourself. Please check that this 
otherwise.
is the latest version of the form available from our 
It will take less than one hour to fill in this part of the 
website.
application form. 
Where you see the term ‘document reference’ on the form, 
Please read through this form and the guidance 
give the document references and send the documents with 
notes that came with it. 
the application form when you’ve completed it.
The form can be:
Contents 
1  Saved onto a computer and then filled in. Please note 
1  About you 
that the form follows a logic that means questions will open 
2  Applications from an individual 
or stay closed depending on a previous answer. So you may 
3  Applications from an organisation of individuals 
not be able to enter text in some boxes.
4  Applications from public bodies 
2  Printed off and filled in by hand. Please write clearly in 
5  Applications from companies 
the answer spaces. 
6  Your address 
Note: if you believe including information on a public register 
7  Contact details 
would not be in the interests of national security you must 
8  How to contact us
1  About you
Are you applying as an individual, an organisation of individuals (for example, a partnership), a company (this includes Limited 
Liability Partnerships) or a public body?
An individual 
 
w  Now go to section 2
An organisation of individuals (for example, a partnership)  
w  Now go to section 3
A public body    
w  Now go to section 4
A registered company or other corporate body  

✔ Now go to section 5
2  Applications from an individual
2a  Please give us the following details
Name      
Title (Mr, Mrs, Miss and so on) 
First name   
 
Last name   
 
Date of birth (DD/MM/YYYY) 
Now go to section 6
3  Applications from an organisation of individuals
3a  Type of organisation 
For example, a charity, a partnership, a group of 
individuals or a club  
3b  Details of the organisation   
If you are an organisation of individuals, please give the details   
of the main representative below. If relevant, provide details of   
other members (please include their title Mr, Mrs and so on) 
on a separate sheet and tell us the document reference 
you have given this sheet. 
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Form EPA: Application for an environmental permit – Part A about you
3  Applications from an organisation of individuals, continued
Contact name
Title (Mr, Mrs, Miss and so on) 
First name   
 
Last name   
 
Date of birth (DD/MM/YYYY) 
Now go to section 6
4  Applications from public bodies 
4a  Type of public body 
For example, NHS trust, local authority, English county council 
4b  Name of the public body 
4c  Please give us the following details of the executive 
An officer of the public body authorised to sign on your behalf
Name
Title (Mr, Mrs, Miss and so on) 
First name   
 
Last name   
 
Position  
 
 
Now go to section 6
5  Applications from companies or corporate bodies
5a  Name of the company 

5 Star Fish Ltd
5b  Company registration number 
 
 
            07208651 
Date of registration (DD/MM/YYYY) 
05/10/2015
If you are applying as a corporate organisation that is not a limited company, please provide evidence of your status and tell us below 
the reference you have given the document containing this evidence.
Document reference 
N/A
Now go to section 6
5c  Please give details of the directors
If relevant, provide details of other directors on a separate sheet and tell us the reference you have given this sheet. 
Document reference 
Details of directors
Title (Mr, Mrs, Miss and so on) 
Mr
First name    
 
Mark 
Last name   
 
Carnaghan
Date of birth (DD/MM/YYYY) 
03/09/1970
EPA Version 11, April 2018 
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Form EPA: Application for an environmental permit – Part A about you
6  Your address
6a  Your main (registered office) address
For companies this is the address on record at Companies House.
Contact name
Title (Mr, Mrs, Miss and so on) 
Mr
First name   
 
Mark
Last name   
 
Carnaghan
Address  
 
 
Trinity Park House           
      
Trinity Business Park
      
Fox Way, Wakefield, West Yorkshire
      
Postcode    
WF2 8EE 
Contact numbers, including the area code
Phone    
 
01924 831300 
Fax  
   
 
Mobile    
 
Email      
xxxx@xxxx.xxx
      
      
For an organisation of individuals every partner needs to give us their details, including their title Mr, Mrs and so on. So, if necessary, 
continue on a separate sheet and tell us below the reference you have given the sheet.
Document reference for the extra sheet 
6b  Main UK business address (if different from above)
Contact name
Title (Mr, Mrs, Miss and so on) 
 
First name   
 
Last name   
 
Address  
 
 
      
      
      
Postcode    
Contact numbers, including the area code
Phone    
 
Fax  
   
 
Mobile    
 
Email      
      
      
Now go to section 7
EPA Version 11, April 2018 
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Form EPA: Application for an environmental permit – Part A about you
7  Contact details
7a  Who can we contact about your application?
This can be someone acting as a consultant or an ‘agent’ for you.
Contact name
Title (Mr, Mrs, Miss and so on) 
Miss
First name   
 
Sarah
Last name   
 
Griffiths
Address  
 
 
C/O Recipe Dish
      
Unit 1 Pegasus Way
      
Grimsby
      
Postcode    
DN37 9TS 
Contact numbers, including the area code
Phone    
 
01472 243661
Fax  
   
 
Mobile    
 
Email      
xxxxx.xxxxxxxxx@xxxx.xxx
      
      
7b  Who can we contact about your operation (if different from question 7a)?
Contact name
Title (Mr, Mrs, Miss and so on) 
 
First name   
 
Last name   
 
Address  
 
 
      
      
      
Postcode    
Contact numbers, including the area code
Phone    
 
Fax  
   
 
Mobile    
 
Email      
      
      
EPA Version 11, April 2018 
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Form EPA: Application for an environmental permit – Part A about you
7  Contact details, continued
7c  Who can we contact about your billing or invoice?
As in question 7a 
w
As in question 7b 
w
Please give details below if different from question 7a or 7b.
Contact name
Title (Mr, Mrs, Miss and so on) 
Mr
First name   
 
Daniel
Last name   
 
Cook 
Address  
 
 
C/O Recipe Dish
      
1 Pegasus Way
      
Grimsby 
      
Postcode    
DN37 9TS
Contact numbers, including the area code
Phone    
 
Fax  
   
 
Mobile    
 
Email      
xxxxxx.xxxx@xxxx.xxx
      
      
8  How to contact us 
If you need help filling in this form, please contact the person who sent it to you or contact us as shown below. 
General enquiries: 03708 506 506 (Monday to Friday, 8am to 6pm) 
Textphone: 03702 422 549 (Monday to Friday, 8am to 6pm) 
Email: xxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx 
Website: www.gov.uk/government/organisations/environment-agency 
If you are happy with our service, please tell us. It helps us to identify good practice and encourages our staff. If you’re not happy 
with our service, or you would like us to review a decision we have made, please let us know. More information on how to do this is 
available at: www.gov.uk/government/organisations/environment-agency/about/complaints-procedure 
Please tell us if you need information in a different language or format (for example, in large print) so we can keep in 
touch with you more easily.
EPA Version 11, April 2018 
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Form EPA: Application for an environmental permit – Part A about you
Feedback
(You don’t have to answer this part of the form, but it will help us improve our forms if you do.)
We want to make our forms easy to fill in and our guidance notes easy to understand. Please use the space below to give us any 
comments you may have about this form or the guidance notes that came with it.
How long did it take you to fill in this form? 
We will use your feedback to improve our forms and guidance notes, and to tell the Government how regulations could be
made simpler.
Would you like a reply to your feedback?
Yes please   
 

No thank you 
 
w
For Environment Agency use only
Date received (DD/MM/YYYY)
Payment received?
No  w
Our reference number
Yes w   
Amount received
  £
EPA Version 11, April 2018 
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