PH LC 5.

6
CU TRC V NI DUNG CA K HOCH BO V MI TRNG
THUC THM QUYN XC NHN NG K
CA Y BAN NHN DN CP HUYN
(Ban hnh km theo Thng t s 27/2015/TT-BTNMT ngy 29 thng 5 nm 2015
ca B trng B Ti nguyn v Mi trng v nh gi mi trng chin lc,
nh gi tc ng mi trng v k hoch bo v mi trng)
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
---------------
(a im), ngy.. thng .. nm 20
Knh gi: (1)
Gi n (1) k hoch bo v mi trng ng k vi cc ni dung sau y:
I. Thng tin chung
1.1. Tn d n, c s (gi chung l d n):...
1.2. Tn ch d n: ...
1.3. a ch lin h: ...
1.4. Ngi i din theo php lut: ...
1.5. Phng tin lin lc vi ch d n: (s in thoi, s Fax, E-mail...).
II. Thng tin c bn v hot ng sn xut, kinh doanh
2.1. a im thc hin d n:

2.3. Loi hnh sn xut, kinh doanh, dch v; sn phm v s lng



2.4. Din tch mt bng c s sn xut, kinh doanh, dch v (m2):
2.5. Nhu cu nguyn liu, vt liu s dng trong qu trnh sn xut:


2.6. Nhin liu s dng trong qu trnh sn xut (du, than, ci, gas, in...)


III. K hoch bo v mi trng trong giai on thi cng xy dng

Yu t gy tc Tnh trng Tnh trng

Bin php gim thiu
ng C Khng C Khng
Kh thi t cc S dng phng tin, my mc thi cng
phng tin qua kim nh
vn chuyn, S dng loi nhin liu t gy nhim
my mc thi
cng nh k bo dng phng tin, thit b
Bin php khc:

Bi Cch ly, phun nc gim bi
Bin php khc:

Nc thi sinh Thu gom, t x l trc khi thi ra mi
hot trng (ch r ngun tip nhn nc
thi)
Thu gom, thu n v c chc nng
x l
thng ra h thng thot nc thi
khu vc
Bin php khc:
Nc thi xy Thu gom, x l trc khi thi ra mi
dng trng (ch r ngun tip nhn nc
thi)
thng ra h thng thot nc thi
khu vc
Bin php khc:

Cht thi rn Thu gom ti ch hoc ti s dng
xy dng T thi ti cc a im quy nh ca
a phng (ch r a im)
 Thu n v c chc nng x l
Bin php khc:

Cht thi rn T thi ti cc a im quy nh ca
sinh hot a phng (ch r a im)
Thu n v c chc nng x l
Bin php khc:

Cht thi nguy Thu n v c chc nng x l
hi Bin php khc:

Ting n nh k bo dng thit b
B tr thi gian thi cng ph hp
Bin php khc

Rung nh k bo dng thit b
B tr thi gian thi cng ph hp
Bin php khc
Nc ma C h thng rnh thu nc, h ga thu
chy trn gom, lng lc nc ma chy trn trc
khi thot ra mi trng
Bin php khc

IV. K hoch bo v mi trng trong giai on hot ng

Yu t gy tc Tnh trng Tnh trng

Bin php gim thiu
ng C Khng C Khng
Bi v kh thi Lp t h thng x l bi v kh thi
vi ng khi
Lp t qut thng gi vi b lc khng
kh cui ng ng
Bin php khc

Nc thi sinh Thu gom v ti s dng
hot X l s b bng b t hoi trc khi
thi vo h thng thot nc chung
Bin php khc

Nc thi sn Thu gom v ti s dng
xut X l nc thi cc b v thi vo h
thng x l nc thi tp trung
X l nc thi p ng quy chun quy
nh v thi ra mi trng (ch r ngun
tip nhn v quy chun t c sau x
l)
Bin php khc

Nc thi t Thu gom v ti s dng
h thng lm Gii nhit v thi ra mi trng
mt
Bin php khc

Cht thi rn Thu gom ti ch hoc ti s dng
T x l
Thu n v c chc nng x l
Bin php khc

Cht thi nguy Thu n v c chc nng x l
hi Bin php khc

Mi Lp t qut thng gi
Bin php khc

Ting n nh k bo dng thit b
 Cch m gim ting n
Bin php khc

Nhit d Lp t qut thng gi
Bin php khc

Nc ma C h thng rnh thu nc, h ga thu
chy trn gom, lng lc nc ma chy trn trc
khi thot ra mi trng
Bin php khc
V. Cam kt
5.1. Chng ti/ti cam kt thc hin nghim chnh cc quy nh v bo v mi
trng ca Lut Bo v mi trng nm 2014, tun th cc quy nh, tiu chun,
quy chun k thut v mi trng v chu hon ton trch nhim nu vi phm cc
quy nh v bo v mi trng.
5.2. Chng ti/ti cam kt thc hin y cc k hoch bo v mi trng
c nu trn y.
5.3. Chng ti/ti m bo trung thc ca cc thng tin v ni dung in
trong k hoch bo v mi trng ny./.

(2)
(K, ghi h tn, chc danh, ng du (nu c)
Ghi ch: (1) C quan xc nhn ng k k hoch bo v mi trng; (2) i
din c thm quyn ca ch d n.
Yu cu: Bn k hoch bo v mi trng c lp thnh ba (03) bn gc, c
ch k ca ch d n pha di tng trang v k, ghi h tn, chc danh, ng
du (nu c) trang cui cng.