Trade and Industry Department
Government of the Hong Kong Special Administrative Region
Chemical Weapons (Convention) Ordinance (Cap. 578)
ANNUAL NOTIFICATION ON
UNSCHEDULED DISCRETE ORGANIC CHEMICALS (FORM UDOC)
Part A : Details of the facility (Note 1)
1.
Facility name : XYZ CHEMICAL FACTORY
4.
Name of the owner, company or enterprise operating the facility :
XYZ LIMITED
(Please mark ‘X’ in one of the following and provide details:)
□ HKID no.
□ Passport no. ☒BR no.:
87654321-000
□ other relevant registration no. (please specify) :
2.
Business Registration no. :
(if other registration no(s) are provided, please specify) :
5. Name of the operator (Note 2) : HO HO
Position/Post title: OPERATION MANAGER
87654321-000
(Please mark ‘X’ in one of the following and provide details:)
☒ HKID no. □ Passport no.: E 333888(1)
3.
Facility address :
Tel no. :
31A TUEN MUN ROAD, TUEN MUN, N.T.
Fax no. :
3000 0000
6.
Year of past activities reported in this form
(i.e. the "reporting year", must be a calendar year) :
2004
2.
Use Product Group Codes to describe the main activities of the facility :
515, 516
(Note 4)
3.
This facility produced Schedule 1 chemicals as an unavoidable by-product
in an amount exceeding 3% of the total product or produced any other
chemicals that can be used for chemical weapons purposes :
3000 0001
Part B : Activities of the facility
1.
Main activities (Note 3) of the facility (please mark ‘X’ if applicable) :
☒ Production
□ Storage
□ Processing
□ Re-packaging, distribution
☒ Consumption
□ Research and development
□ Yes
☒ No
(please mark ‘X’ )
Part C : Production of UDOC (Note 5) at the facility
1.
The facility named in Part A produced more than 200 tonnes of UDOCs during the reporting year :
☒ Yes
□ No
(please mark ‘X’ )
If yes, please choose one of the following aggregate amount of production of UDOCs (in tonnes) and mark ‘X’:
□ 200 to below 1,000
2.
☒ 1,000 to 10,000
□ above 10,000
Please provide the number of plants at the facility that produced any amount of UDOCs including PSF-chemicals :
2
Part D : Production of PSF-chemicals at the facility
1.
The facility named in Part A produced by synthesis more than 30 tonnes of a PSF-chemical during the reporting year :
☒ Yes
□ No
(please mark ‘X’)
If yes, please indicate the number of plants at the facility that produced an individual PSF-chemical above 30 tonnes :
2.
1
PSF-plants
Please provide the number of PSF-plants at the facility with aggregate production of PSF-chemicals for each of the following with production ranges
(in tonnes) :
(a)
above 30 to below 200
0
(b)
200 to below 1,000
1
(c)
1,000 to 10,000
0
(d)
above 10,000
0
Part E : Total number of Form UDOC submitted (including this page):
1
pages
Part F : Undertaking
I, the undersigned, hereby declare to the best of my knowledge and belief, that all information provided in this form and For official use only
in any additional pages to this form is true and correct. I also declare that, in submitting this form, I fully understand
that Trade and Industry Department reserves at all times the right to release the above information and any information
relates to this report, including particulars of the undersigned, to third parties for purposes stated in Section 28(2) of the Date of receipt :
Chemical Weapons (Convention) Ordinance (Cap. 578).
Name of the operator of the facility : HO HO
Signature for and on behalf of the operator and company chop :
HO HO
Date : 8 JANUARY 2005
[Form UDOC(2005).DOC]
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For and on behalf of
XYZ Chemical Factory
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Remarks :