EVIDENCE FORM

Lorry Control Scheme – London Councils

Case Reference No:

EVIDENCE TYPE Please Total

tick no. of
one sheets *
B. Case Summary & Traffic Management Order * 3
D. Registered Keeper Details and Notice to
Owner/Enforcement Notice
E. Correspondence, Representations and Notice of Rejection
(include covering letter sent with the evidence to the appellant)
F. Clamp/Removal Payment details
G. Meter/Pay and Display Maintenance Record
H. Map/Site Report
I. Payment Details (PCN Appeals Only)
J. Additional Evidence
* TOTAL SHEETS INCLUDING THIS FORM 3

NOTES FOR THE ADJUDICATOR:

……………………………………………………………………………
……………………………………………………………………………
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……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………

PATAS Forms Version 7.1

 London Tribunals Case Number
Verification Code
Appellant London Borough of Hackney
Penalty Charge Notice
Enforcement Officer Number
Date 12 January 2022

I enclose details of the case summary for the above appeal scheduled to take place on 28
January 2022.

On the 20 November 2021, officer was on duty at Kingsland Road (E2), which is a
restricted street for the purposes of the Greater London (Restriction of Goods Vehicles
Traffic Order 1985. A heavy goods vehicle, bearing vehicle registration mark , was
seen travelling North at 23:38. Contemporaneous notes of the aforementioned details were
made in the Enforcement Officers pocket notebook. It is believed that the vehicle had a
gross plated weight in excess of 18 tonnes.

The VRM was later checked against the London Councils database of hauliers with
exemption permissions. It was found that the vehicle did not have an exemption permission.

Representations were received on the 3 December 2021, stating that please find attached
beat sheet and daily worksheet for 10pm Loop, an evening time banded collection, which
starts at 20:00. This is one of Hackney Councils Waste beats and as you will see from the
documentation supplied shows our driver was in making collections in and around that area
at that time of the night. As a council we have a responsibility and duty of care to clear waste
from commercial and residential premises alike. The driver was who is an
employee of London Borough of Hackney. Any further correspondence should be sent for
my attention as the Transport Manager of LBH and not directly to . Due to our data
protection laws I am unable to provide you with any further details on at this time.
Having explained the vehicles presence, I request that you reconsider the PCN on the
grounds that our driver was undertaking his regular duty of removing refuse in order that
Hackney and London’s streets alike are kept clean and tidy at all times.

Attached was a daily work sheet.

The case was reviewed accordingly and on the 3 December 2021, a Notice of Rejection
(NoR) was issued. The NoR explained that because the vehicle was not covered by an
exemption permission on the 20 November 2021.

On the 17 December 2021 a Notice of Appeal was received, stating that further to the
rejection letter from London Councils dated the 3 December, we write to appeal their
decision for the following reasons.

We are a local government and at the time of the contravention our vehicle was in the vicinity
making collections of refuse/recycling. We have had numerous enquiries from London
Councils as you will see from a copy of our Excel and we have always had our appeal
accepted.

We had made the relevant appeal on-line and attached the relevant beat sheets, please see
attached. We actually had 2 enquiries 1 after the other and one was accepted (21.11.21-
attached acceptance letter from London Councils) and one was denied.

We hope after reviewing the relevant information you agree.

 for and on behalf of London Borough of Hackney

Attached was a copy of the beat sheets

Attached was a copy of a London Councils enquiry letter for a different case

Attached was a copy of the daily work sheet

Attached was a copy of the Notice of Rejection of Representations

Attached was a copy of an online representation

No further information had been received to change London Councils belief that the
documentation provided validated the need for the vehicle to be observed in contravention of
the London Lorry Control Scheme.

London Councils would like to state that vehicle was travelling on a restricted
route during the prescribed hours without valid permission.

Our records show that vehicle did not have such permission when it was observed
on the 20 November 2021 on Kingsland Road (E2).

This appeal is being contested because the vehicle was seen and noted at the material time,
being used and driven on a restricted road during the prescribed hours without a valid
permission.

Signed: Date: 12 January 2022

 EVIDENCE FORM C
Lorry Control Scheme – London Councils

Case Reference No:

Penalty Charge No:

EVIDENCE TYPE Total

no. of
sheets*
C. Penalty Charge Notice(s) and PA’s/CEO’s notes /Statements by
Witnesses/Photographs / Certified copy of Penalty Charge Notice 4
[one form C for each PCN]

INCLUDE: Penalty Amount: £550

* TOTAL SHEETS INCLUDING THIS FORM

4

NOTES FOR THE ADJUDICATOR:

Pocket book note attached

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………

PATAS Forms Version 7.1

PENALTY CHARGE NOTICE
London Lorry Control Scheme
Greater London (Restriction of Goods Vehicles) Traffic Order 1985
London Local Authorities & Transport for London Act 2003

London Borough Of Hackney

Penalty Charge Notice:
Vehicle Registration Number:
Case reference:
Date of this Notice: 23rd November 2021

OPERATOR'S NOTICE

London Councils TEC, acting on behalf of the London Borough Councils, believes that a Penalty
Charge is payable by you with respect to the above vehicle, for the following alleged contravention:

Using a vehicle on a restricted street during prescribed hours without a valid permit.

The vehicle was seen at: Kingsland Road (E2)

On: 20th November 2021 At: 23:38

The goods vehicle, exceeding 18 tonnes maximum gross weight, was using, driving or causing
or permitting to be driven in a restricted street during prescribed hours.

The alleged contravention was noted by Enforcement Officer Number:

DO NOT IGNORE THIS NOTICE

You must pay the penalty charge of £550 before the end of the period of 28 days beginning with the date of this Notice. If you pay
before the end of the period of 14 days beginning with the date of this Notice, the amount you have to pay is reduced to £275.
Payment can be made by any of the methods set out overleaf. If you believe you have valid reasons to challenge the penalty
charge, then you may make representations via our website www.londoncouncils.gov.uk/lorrycontrol and go to Haulier Portal,
Manage case and Make Representation which shows the grounds on which you may make representations. Alternatively,
you may make representations in writing to the address below. London Councils may disregard any representations made after the
period of 28 days beginning with the date of service of this Notice. If you do neither of these things, the penalty charge may
increase to £825 and we may serve a Charge Certificate seeking payment of this increased amount. At that stage, it would be too
late to make any representations.

Before the end of the period of 28 days, beginning with the date of this Notice, you must provide us with the name and address of
the person who was in control of the vehicle (the "Driver") when the alleged contravention took place. To do this, via the London
Lorry Control website www.londoncouncils.gov.uk/lorrycontrol go to Haulier Portal and Manage case and follow the
instructions. Alternatively you can also use the slip below and send your correspondence, including any representations,
to London Lorry Control, 59½ Southwark Street, London, SE1 0AL.

If you fail to provide this information, or provide false information, you may be guilty of an offence, for which you could be
fined up to £1,000.

____________________________________________________________________

Name of Driver:_________________________________________________________________________

Address: ______________________________________________________________________________
REPRESENTATIONS
If you have any reason to believe that you should not be liable for the payment of this penalty charge, please login
to http://www.londoncouncils.gov.uk/lorrycontrol and follow the instructions on the London Lorry Control website, that
show the grounds on which you may make representations. Alternatively, you may make representations in writing to the
address below explaining why you should not be liable for the penalty charge. There are only three legal grounds to make
representations. If you think any of these apply, please indicate which one by circling the number and giving details in the space
provided.

1. There was no contravention of the London Lorry Control Scheme at the time - please explain why you think the contravention did
not occur.
(Note: Please supply documentary evidence to support your representations.)
2. I was not the operator of the vehicle at the time.
(Note: Please supply documentary evidence of the name and address of the operator.)
3. The penalty charge exceeded the amount applicable in the circumstances of the case - (if you think you are being asked to
pay more than you should legally pay).

Details (if you have ticked ground 2, you must provide the name and address of the operator).

(Please continue on another sheet of paper if necessary)

The following declaration must be signed for your representation to be considered.

I confirm that the above information is correct to the best of my knowledge. I understand that making a false statement may result
in prosecution and a possible fine of up to £1,000.

__________________________________ (name in BLOCK CAPITALS) _________________________________ (signature)

__________________________________ (position in company) ________________________________________(date)

After we have considered your representations, we will write to you with our decision. If we accept your representations, we will
cancel this Penalty Charge Notice and you will not have to pay the penalty charge. If we do not accept your representation, you will
have a further 28 days to either pay the penalty charge or appeal our decision to an Independent Traffic Adjudicator. We will tell you
how to do this when we write to you.

Privacy Notice
Data collected through the issuing of this Penalty Charge Notice will be used for enforcement of traffic contraventions and other
associated purposes. This data may also be disclosed to London Tribunals and other enforcement agencies for appeals and
enforcement. For full details on why and how we use your data please go to
www.londoncouncils.gov.uk/file/gdpr-pcn-and-permissions-privacy-statement-v4pdfv

HOW TO PAY
ONLINE: Go to www.londoncouncils.gov.uk/lorrycontrol and follow the instructions on the website.

BY TELEPHONE: Call 0203 879 4231 24 hours a day/7 days a week using a valid debit or credit card.

BY POST: Complete the payment-slip below and return to: London Lorry Control, 591/2 Southwark Street, London, SE1 0AL,
together with either a cheque or postal order payable to "London Councils". All cheques/postal orders must have the PCN number
and Vehicle Registration Number written on the back. We do not recommend cash payment by post.

Please do not make any payment if you want to challenge this PCN.

PAYMENT SLIP
Penalty Charge Notice Number:
Vehicle Registration Number:
Issued at: Kingsland Road (E2) on 20th November 2021 at 23:38
Amount Due: £550

Payee Name: Mr/Mrs/Ms/Miss/Company _____________________________________________________________

Payee Address: _______________________________________________________ Postcode: _________________

 EVIDENCE FORM
Lorry Control Scheme – London Councils

Case Reference No:

EVIDENCE TYPE Please Total

tick no. of
one sheets *
B. Case Summary & Traffic Management Order
D. Registered Keeper Details and Notice to * 3
Owner/Enforcement Notice
E. Correspondence, Representations and Notice of Rejection
(include covering letter sent with the evidence to the appellant)
F. Clamp/Removal Payment details
G. Meter/Pay and Display Maintenance Record
H. Map/Site Report
I. Payment Details (PCN Appeals Only)
J. Additional Evidence
* TOTAL SHEETS INCLUDING THIS FORM 3

NOTES FOR THE ADJUDICATOR:

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………

PATAS Forms Version 7.1

PENALTY CHARGE NOTICE
London Lorry Control Scheme
Greater London (Restriction of Goods Vehicles) Traffic Order 1985
London Local Authorities & Transport for London Act 2003

London Borough Of Hackney

Penalty Charge Notice:
Vehicle Registration Number:
Case reference:
Date of this Notice: 23rd November 2021

OPERATOR'S NOTICE

London Councils TEC, acting on behalf of the London Borough Councils, believes that a Penalty
Charge is payable by you with respect to the above vehicle, for the following alleged contravention:

Using a vehicle on a restricted street during prescribed hours without a valid permit.

The vehicle was seen at: Kingsland Road (E2)

On: 20th November 2021 At: 23:38

The goods vehicle, exceeding 18 tonnes maximum gross weight, was using, driving or causing
or permitting to be driven in a restricted street during prescribed hours.

The alleged contravention was noted by Enforcement Officer Number:

DO NOT IGNORE THIS NOTICE

You must pay the penalty charge of £550 before the end of the period of 28 days beginning with the date of this Notice. If you pay
before the end of the period of 14 days beginning with the date of this Notice, the amount you have to pay is reduced to £275.
Payment can be made by any of the methods set out overleaf. If you believe you have valid reasons to challenge the penalty
charge, then you may make representations via our website www.londoncouncils.gov.uk/lorrycontrol and go to Haulier Portal,
Manage case and Make Representation which shows the grounds on which you may make representations. Alternatively,
you may make representations in writing to the address below. London Councils may disregard any representations made after the
period of 28 days beginning with the date of service of this Notice. If you do neither of these things, the penalty charge may
increase to £825 and we may serve a Charge Certificate seeking payment of this increased amount. At that stage, it would be too
late to make any representations.

Before the end of the period of 28 days, beginning with the date of this Notice, you must provide us with the name and address of
the person who was in control of the vehicle (the "Driver") when the alleged contravention took place. To do this, via the London
Lorry Control website www.londoncouncils.gov.uk/lorrycontrol go to Haulier Portal and Manage case and follow the
instructions. Alternatively you can also use the slip below and send your correspondence, including any representations,
to London Lorry Control, 59½ Southwark Street, London, SE1 0AL.

If you fail to provide this information, or provide false information, you may be guilty of an offence, for which you could be
fined up to £1,000.

____________________________________________________________________

Name of Driver:_________________________________________________________________________

Address: ______________________________________________________________________________
REPRESENTATIONS
If you have any reason to believe that you should not be liable for the payment of this penalty charge, please login
to http://www.londoncouncils.gov.uk/lorrycontrol and follow the instructions on the London Lorry Control website, that
show the grounds on which you may make representations. Alternatively, you may make representations in writing to the
address below explaining why you should not be liable for the penalty charge. There are only three legal grounds to make
representations. If you think any of these apply, please indicate which one by circling the number and giving details in the space
provided.

1. There was no contravention of the London Lorry Control Scheme at the time - please explain why you think the contravention did
not occur.
(Note: Please supply documentary evidence to support your representations.)
2. I was not the operator of the vehicle at the time.
(Note: Please supply documentary evidence of the name and address of the operator.)
3. The penalty charge exceeded the amount applicable in the circumstances of the case - (if you think you are being asked to
pay more than you should legally pay).

Details (if you have ticked ground 2, you must provide the name and address of the operator).

(Please continue on another sheet of paper if necessary)

The following declaration must be signed for your representation to be considered.

I confirm that the above information is correct to the best of my knowledge. I understand that making a false statement may result
in prosecution and a possible fine of up to £1,000.

__________________________________ (name in BLOCK CAPITALS) _________________________________ (signature)

__________________________________ (position in company) ________________________________________(date)

After we have considered your representations, we will write to you with our decision. If we accept your representations, we will
cancel this Penalty Charge Notice and you will not have to pay the penalty charge. If we do not accept your representation, you will
have a further 28 days to either pay the penalty charge or appeal our decision to an Independent Traffic Adjudicator. We will tell you
how to do this when we write to you.

Privacy Notice
Data collected through the issuing of this Penalty Charge Notice will be used for enforcement of traffic contraventions and other
associated purposes. This data may also be disclosed to London Tribunals and other enforcement agencies for appeals and
enforcement. For full details on why and how we use your data please go to
www.londoncouncils.gov.uk/file/gdpr-pcn-and-permissions-privacy-statement-v4pdfv

HOW TO PAY
ONLINE: Go to www.londoncouncils.gov.uk/lorrycontrol and follow the instructions on the website.

BY TELEPHONE: Call 0203 879 4231 24 hours a day/7 days a week using a valid debit or credit card.

BY POST: Complete the payment-slip below and return to: London Lorry Control, 591/2 Southwark Street, London, SE1 0AL,
together with either a cheque or postal order payable to "London Councils". All cheques/postal orders must have the PCN number
and Vehicle Registration Number written on the back. We do not recommend cash payment by post.

Please do not make any payment if you want to challenge this PCN.

PAYMENT SLIP
Penalty Charge Notice Number:
Vehicle Registration Number:
Issued at: Kingsland Road (E2) on 20th November 2021 at 23:38
Amount Due: £550

Payee Name: Mr/Mrs/Ms/Miss/Company _____________________________________________________________

Payee Address: _______________________________________________________ Postcode: _________________

 TTMEBANDED EVENTNG LOOP (10.00 pM START)

Lower Clapton Road (both sides)

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Downs Road
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WellStreet
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Kenworthy Road
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Westgate Street
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Broadway Market
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Kingsland Road (south bound)
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Kingsland Road (north bound)
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Shoreditch H Street (both sídes)
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Charlotte Road
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Great Eastern S-treet (both sides)
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LOADER
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DAY;
 TTMEBANDED EVENTNG LOOP (10.00 PM START)

TIME TIME
LOCATION IN ÔIIT INSTRUCTIONS COMMENTS
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Shoreditch High St (north bound)
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Stoke Newington Road (north bound)
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 EVIDENCE FORM
Lorry Control Scheme – London Councils

Case Reference No:

EVIDENCE TYPE Please Total

tick no. of
one sheets *
B. Case Summary & Traffic Management Order
D. Registered Keeper Details and Notice to
Owner/Enforcement Notice
E. Correspondence, Representations and Notice of Rejection * 10
(include covering letter sent with the evidence to the appellant)
F. Clamp/Removal Payment details
G. Meter/Pay and Display Maintenance Record
H. Map/Site Report
I. Payment Details (PCN Appeals Only)
J. Additional Evidence
* TOTAL SHEETS INCLUDING THIS FORM 10

NOTES FOR THE ADJUDICATOR:

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………

PATAS Forms Version 7.1

 MAYOR'S PRIORITIES
REFUSE . Sofer. Cleoner, Greener HockneY
. Children ond Young PeoPle
DAILY WORK SHEET . Affordcrble ond Decent Homes
. Mokinq Sure the Council is lligh
Pleose ensure thot you ovoid collections in the vicinity Performing ond Effi cient
of schools ond colleges ot stort, finish qnd breok times

Round No
lø (v Vehicle
Registrotion
2nd Vehicle
Registrotion

Time storted
Dqte Fuel odded todoY ,,----¿
t" 2nd vehicle in/
In mileoge 2nd vehicle out/
Out Mileoge

Monogement I nstructions

START FINISH ARRIVAL DEPARTURE

TIP SITE
TIPPING WEIGHT ON WEIGHT OFF TIME
LOADING LOADING TIME
TIME TIME

2nd

3rd

4rh

START TIME FINISH TIME

CREW NAME lOB TITLE

€ NO

YES @
Hove you hod o RTA todoY?
qccident todoy? YES
Hove you or onY of your crew hod o personol

Dote:
Driver print nome:

Driver signoture:

Supervisors nome:
Dote: 2-\-(t-
Supervisors signoture:

Any other relevont informotion pleose use the other side of this
form i'e' work left down' bin repoirs etc'

HHac*ney
 Bin Repoirs or Replocement Informotion
ROAD OR ESTATE
BLOCK OR DOOR NUMBER
PROBLEM

To be completed in the obsence of a Defect

Book

DEFECT REPORT
TICK/CROSS
Lights, Mirrors, Horn?

Tyres ond Wheel Fixing

Steering qnd Brokes

Wipers, Wcsher, windscreen OK?

Hydroulic Oil, Adblue, Tcchogroph OK?

Sofety Devices (Stop Buttons) Bin Lift

&Guords?

Accident Domoge on Body Work

Heqlth & Sofety Kit / Fire Extinguisher

Any other information / Defects

Incident Report

Whot hoppened:

Print Nome @
N
N
€
o
T
Signoture

HHacil<ney
 London Borough Of Hackney Contact: Lorry Control Unit
Direct line: 020 7934 9697
Email: lorry.control@londoncouncils.gov.uk
Case reference:
Date: 3rd December 2021

LONDON LORRY CONTROL SCHEME

GREATER LONDON (RESTRICTION OF GOODS VEHICLES) TRAFFIC ORDER 1985
LONDON LOCAL AUTHORITIES TRANSPORT FOR LONDON ACT 2003

Dear London Borough Of Hackney

NOTICE OF REJECTION OF REPRESENTATIONS

Penalty Charge Notice:

Verification Code:
Vehicle Registration Number:
Observed at: Kingsland Road (E2)
On:20th November 2021 At: 23:38

I refer to the representations made by you when you contacted us about the above Penalty Charge Notice.

Your representations have been considered by this office in accordance with the requirements of the
London Local Authorities and Transport for London Act 2003. After full consideration of the representations
made and all other circumstances relating to the issue of the Penalty Charge Notice, I have to advise that
grounds for successful representations have not been established.

Reason:
Under the Greater London (Restriction of Goods Vehicles) Traffic Order 1985, vehicles over 18
tonnes maximum gross weight are prohibited from travelling on restricted routes during the
prescribed hours without valid permission. Our records show that the above vehicle did not have
such permission when it was observed.

Therefore, before the end of the period of 28 days beginning with the date of service of this Notice, you
should either pay the penalty charge or appeal against our decision.

London Councils, 59½ Southwark Street, London SE1 0AL Tel: 020 7934 9697
Email: lorry.control@londoncouncils.gov.uk Web: http://www.londoncouncils.gov.uk
Because you replied within 14 days, during which you could have paid the penalty charge at the discounted
rate, we have decided to offer you a further 14 days from the date of this Notice, during which you can pay
the reduced amount of £275. If you have not paid before the end of 14 days, you will have to pay the full
penalty charge of £550.

If you choose to appeal, you should read the form accompanying this Notice, then complete the form and
send it to London Tribunals PO Box 10598, Nottingham NG6 6DR or appeal online at
www.londontribunals.gov.uk . Please note that you must appeal within 28 days and that there are set
grounds for an appeal, which are explained in the notes.

The Adjudicator will consider the appeal, based on the evidence provided by both sides and make a
decision, which is final. A copy of any evidence we supply will be sent to you before the appeal is heard.

You should be aware that there are limited grounds for an Adjudicator to award costs in connection to an
appeal; this is explained in the notes. Also, please note that if you appeal and are unsuccessful, you will be
expected to pay the full charge of £550, unless the Adjudicator finds otherwise.

If you do not either pay or appeal before the end of a period of 28 days, beginning with the date of service
of this Notice, we may issue a Charge Certificate, at which stage the penalty charge will increase to £825
and it will be too late for you to appeal. If the increased penalty charge is then not paid within a further 14
days, we may apply to the County Court to recover the charge as if it were a debt payable under a County
Court order, and this may result in bailiffs being used to recover the debt. We therefore strongly advise you
to deal with the matter now by paying or appealling.

Regards

London Councils, 59½ Southwark Street, London SE1 0AL Tel: 020 7934 9697
Email: lorry.control@londoncouncils.gov.uk Web: http://www.londoncouncils.gov.uk
HOW TO PAY
ONLINE: Go to http://www.londoncoucils.gov.uk/lorrycontrol and follow the instructions on the website.
BY TELEPHONE: Call 020 3879 4231: 24 hours a day/7 days a week using a valid debit or credit card.
BY POST: Complete the payment-slip below and return it to: London Lorry Control, 591/2 Southwark Street,
London, SE1 0AL, together with either a cheque or postal order payable to "London Councils".
All cheques or postal orders must have the PCN number and Vehicle Registration Number written on the
back. We do not recommend cash payments by post.
Please do not make any payment if you want to challenge this PCN

Payment slip
Penalty Charge Notice:
Vehicle Registration Number:
Issued at: Kingsland Road (E2) On: 20th November 2021 At: 11:38 PM
Amount Due: £550

Payee Name: Mr/Mrs/Ms/Miss/Company: _____________________________________________

Payee Address: __________________________________________ Postcode: _____________

London Councils, 59½ Southwark Street, London SE1 0AL Tel: 020 7934 9697
Email: lorry.control@londoncouncils.gov.uk Web: http://www.londoncouncils.gov.uk
London Borough Of Hackney

3rd December 2021

1
Response to Penalty Charge Notice received on the 3 December 2021
Please find attached beat sheet and daily worksheet for 10pm Loop, an evening time banded
collection, which starts at 20:00. This is one of Hackney Councils Waste beats and as you
will see from the documentation supplied shows our driver was in making collections in and
around that area at that time of the night. As a council we have a responsibility and duty of
care to clear waste from commercial and residential premises alike. The driver was
who is an employee of London Borough of Hackney. Any further correspondence should be
sent for my attention as the Transport Manager of LBH and not directly to . Due to
our data protection laws I am unable to provide you with any further details on at
this time. Having explained the vehicles presence, I request that you reconsider the PCN on
the grounds that our driver was undertaking his regular duty of removing refuse in order that
Hackney and London’s streets alike are kept clean and tidy at all times.
 EVIDENCE CHECKLIST
Lorry Control Scheme – London Councils

Case Reference No:

Appellant: London Borough of Hackney

VRM:

Scheduled Hearing Date:28/01/2022 Hearing Type:POSTAL

(Please delete as appropriate)

We have confirmed the following information with the details held on record: Please tick
1. Vehicle Registration Mark
2. Penalty Charge Notice(s)
3. The Appellant is the person to whom the NtO/Enforcement Notice
was sent

We have enclosed the following types of evidence: Please tick

A. Evidence Checklist *
B. Case Summary and Traffic Management Order *
C. Penalty Charge Notice(s) and PA’s/CEO’s notes *
Statements by Witnesses & Photographs
Certified copy of Penalty Charge Notice
[one form C for each PCN]
D. Registered Keeper Details and Notice to Owner/Enforcement *
Notice
E. Correspondence, Representations and Notice of Rejection *
(include covering letter sent with the evidence to the Appellant)
F. Clamp/Removal Payment details
G. Meter/Pay and Display Maintenance Record
H. Map/Site Report
I. Payment Details (PCN Appeals Only)
J. Additional Evidence
K. Online Media
TOTAL NUMBER OF EVIDENCE FORMS (INCLUDE THIS CHECKLIST) 5

I confirm that Appellant has been sent Date Sent to Appellant: Signature:
copies of all evidence in accordance
with the Adjudicators’ requirements. 12 January 2022

PATAS Forms Version 7.1

PATAS Forms Version 7.1