1、  综述

 

1.1  运营人法定全名

Full Legal Name of Operator                                              

 

 

 

 

1.2  运营人对空运危险品负全部责任的人员姓名：

     Name of Responsible Person for DG Transportations

 

 

1.3  运营人地址：

Address of applicant

 

 

   

 

 

1.4 运营人信息/Information of the Operator：

 

(a)电话号码 /Telephone            (b)传真号码/Fax

                            

                                                                                 

 

(c)运营人三字代码 /Operator 3 letter code (d)电子邮箱/Email

 

                                                            

 

 

(e).申请人通讯地址/Address

 

                                                             

 

 

2. 申请许可的类别/Type of permission for application

   □临时许可/Temporary   □定期许可/Long Term

 

 

3. 申请理由/Reason of application

□    初次申请/Original application

□    包机飞行/Charter Flight

□变更危险品运输的区域/Change in area of dangerous goods transport by air

□变更危险品运输的种类/Change in category of dangerous goods transported by air

□变更危险品运输的机场/Change in airport of dangerous goods transport by air

4．申请运输的危险品类别/Categories of dangerous goods transported by air for application

                                                                 

 

 

5. 申请实施危险品运输的区域/Area of transport of dangerous goods for application

□国内/domestic      □国际/international

 

 

6. 申请实施危险品运输的机场/Airport of transport of dangerous goods for application

 

序号 No.	机场名称 Name of airport	机场代码. Airport Code	机场货物收运/地面操作代理人名称Name of the Contracted Third Party for Ground Handling

7. 包机飞行的飞行计划/Flight Plan for Chart Flight

 

 

 

 

8. 运营人的人员训练说明，包括指定的从事与货物操作和运输有关的地面操作代理机构的相关信息。包机需附带机组人员训练证明/Descriptions of Training for Operator’s Employee ，Including Employee of The Third Party Ground Handling Agents with Relation to the Handling and Transport of Cargo. For Charter Flight, Training Certificate of the Crews）

 

 

 

 

 

 

 

 

9. 运营人的危险品手册和危险品训练大纲/Operator’s DG Manual and DG Training Programme

 

 

10. 对于包机，运营人危险品运输文件，至少包括物料安全说明书、危险品申报单、检查单、货单、机长通知单、如适用，包装合格证明/For Chart Flight, Dangerous Goods Documentation ，Including MSDS /DGD / Checklist/ Airway Bill/ NOTOC/ Certification for Package if applicable

 

 

 

 

11. 应急处置程序/Emergency Response Procedure

 

 

 

 

12. CCAR276的符合性声明/Statement of Compliance for CCAR276

 

 

13.申请人签字                               职务

  Signature of applicant                       Title                        

  

申请日期

  Date of application                            

 

注：

1、表格一经填好立即交还当局/The form once completed should be returned to the authority.

2、表格填写不完整可能延迟申请审批/Failure to complete this form in full may result in a delay in processing the application。

3、发放此表并非授权运输危险品/The issuing of this form does not in itself constitute an authorization to carry DG。

4、此表格中“运营人”一词特指问题1.1所示含义/  Throughout this form the term  "operator" refers specifically to that so identified in question 1.1.(full legal name of the operator) 

5、随申请附本提交的文件，如使用的是中文或英文以外的其他文字，应附带准确的中文或英文译本/ All the documentation attached that are not written in Chinese or English should be translated into Chinese or English。

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