Form: KCS-E&M-F09

Issue/Rev.: 01/00
Effective Date: 01/12/2016
PAT REPORT
INFORMATION CHECKLIST FOR _____________________________________

Company Name : __________________________________________________________________________

Project Ref. : __________________________________________________________________________
Project Title : __________________________________________________________________________

No. Checklist Item Status (√) Remark

1 Company Info
a) Company name/comp. registration / Address
b) Phone/fax no

2 Project/Operation Info
a) Activity title
b) Site Location (No Lot/Mukim/Daerah/Negeri)
c) Site Total Area
d) Site Coordinate
e) Raw Material
f) Capacity/Quantity (Per Month/Per day)
g) Operation Hours
h) Days of operation
i) Equipment
j) Production Process/Flow Diagram
k) Dust Emission Rate

3 PAT General Form/Letter

a) Form AS PAT 1-12
b) Consultant Appointment Letter
c) PAT Application letter

4 PAT Appendix Info

a) Registration Company Certificate
b) Land Approval Letter
c) Land Title

5 General Plan
a) Location Plan
b) Project Layout Plan
c) Rancangan Tempatan Daerah (RTD)
d) 5km Radius Profile (Topography/Google Plan)

Checked by:

YK Wong
Name: YK Wong
Date: 13/11/2017