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 EPE: Application for an environmental permit – Part E2 surrender application
Application for an environmental permit 
Part E2 – Surrender application (installations, 
waste operations, mining waste operations and 
mobile plant only)
Fill in this part of the form together with part F1, if you 
2  Printed off and filled in by hand. Please write clearly in the 
are surrendering all or part of your permit or applying 
answer spaces.
to surrender mobile plant. Please check that this is the 
It will take less than two hours to fill in this form.  
latest version of the form available from our website.
Please read through this form and the guidance 
1  About the permit 
notes that came with it. 
2  About the application 
The form can be:
3  About the parts of the permit you want to surrender 
4  For all applications 
1  Saved onto a computer and then filled in. Please note 
5  Surrendering mobile plant   
that the form follows a logic that means questions will open 
6  How to contact us
or stay closed depending on a previous answer. So you may 
not be able to enter text in some boxes.
1  About the permit 
1a  Discussions before your application
If you have had discussions with us before your application, provide the permit reference or details on a separate sheet and tell us 
below the reference you have given the document.
Permit or document reference 
1b  Permit number 
What is the permit number that this application relates to? 
1c  Site details
What is the name, address and postcode of the site? (but not mobile plant)
5 Star Fish
Great Grimsby Business Park
DN37 9TS
1d  Type of permit 
Tick below which type of permit you are applying to surrender 
A site permit 

✔ Now go to section 2
Mobile plant permit 
w  Now go to section 5
2  About the application
2a   Is this a low risk surrender application? (see guidance notes on part E2) 
No  w

Yes w
Please attach a copy of the evidence and give us the document reference below.
Document reference  
EPE2 Version 10, April 2018 
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Form EPE: Application for an environmental permit – Part E2 surrender application
2  About the application, continued
2b  Have we confirmed during discussions we have had with you before your application that this will be a low

risk surrender?
No  w
Yes w
Have there been any changes to your proposal since the discussions?
No  w
Yes w
Please send us a copy of confirmation or a letter justifying any changes you have made since pre-application discussions. Give us the 
reference number you have given this document:
Document reference for the justification 
2c  Tick below to show whether you are applying to surrender all or part of your permit
All of permit 

✔ Now go to section 4
Part of permit 
w  Now go to section 3
3  About the parts of the permit you want to surrender and the parts you want to keep 
3a   Fill in Table 1 below with details of all the activities you no longer operate or plan to stop operating 
Fill in a separate table for each activity you are applying to surrender. Use a separate sheet if you have a long list and send it to us 
with your application form.  Tell us below the reference you have given the extra sheet.
Document reference of the extra sheet 
Table 1 – Parts of the permit you want to surrender
Activity reference
Installations only
Description of the 
Description of 
waste facility
the mining waste 
Schedule 1 
Description of 
Directly associated 
the activity
1  a map or plan identifying the part (or parts) of the permit your application relates to. 
Document map or plan reference  
2  a map or plan identifying the part (or parts) of the permit you will be keeping (please clearly mark the new boundary).
Document map or plan reference  
EPE2 Version 10, April 2018 
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Form EPE: Application for an environmental permit – Part E2 surrender application
3  About the parts of the permit you want to surrender and the parts you want to keep, continued
3b  Do you think you will need to apply to vary (change) any of the permit conditions as a result of surrendering part 

of your permit? 
Note: If you are partially surrendering an area of land only it is unlikely that you will need to amend any conditions other than the site 
No  w  Now go to section 4 
Yes w  Fill in the relevant parts of C1 to C7 of the application form, giving details of how the permit conditions will need to be  
changed as a result of surrendering part of the permit 
Document reference of these details 
4  For all applications 
4a    Please provide a site report/baseline report/surrender report which describes the condition of the site, or the 

parts of the permit the application relates to (see guidance notes on part E2).
Document reference of the report 
4b  Have you taken any steps on the site (or the part of the site you are surrendering) to avoid any pollution risks or 
to return the site to a satisfactory condition? 
No  w  
Yes w 
✔ Describe the steps you have taken
Document reference of your explanation 
Section 5 - Document 5SF/SSR/0319
4c  Does a financial provision agreement exist for this site?
(This information will allow the provision to be returned or cancelled correctly on surrender of the permit)
No  w

Yes w
Now fill in part F1.
5      Surrendering mobile plant 
I want to surrender the environmental permit mentioned in 
section 1 above   
5a     Tell us the date on which you want to surrender the plant 
(This must be at least 20 working days from the date you fill this form in.)
Date you want to surrender the plant (DD/MM/YYYY)  
6 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) 
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, please tell us how we can improve it. 
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.
EPE2 Version 10, April 2018 
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Form EPE: Application for an environmental permit – Part E2 surrender application
(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 
For Environment Agency use only
Date received (DD/MM/YYYY)
Payment received?
No  w
Our reference number
Yes w   
Amount received
EPE2 Version 10, April 2018 
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