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Proforma for Notification of Minor Changes to a Mining Proposal
To Team Leader Name: ______________________Resource and Environmental Compliance DivisionDepartment of Mines, Industry Regulation and Safety
This pro forma is designed to allow proponents to notify Department of Mines, Industry Regulation and Safety (DMIRS) of minor changes to a Mining Proposal that they consider to not require approval via a revised Mining Proposal.
ENVIRONMENTAL GROUP SITE (EGS) DETAILS
EGS Name
EGS CodeCode is derived from the EARS2 system.
APPLICANT DETAILS
Company or Individual Name
Tenement Holder(s) (if different from above)
MINING PROPOSAL DETAILS
Registration IDID is derived from the EARS system.MP dateApplication Lodgement Date
DETAILS OF PROPOSED CHANGES (e.g. minor changes to environmental management practices, environmental monitoring, location of infrastructure, etc.).
TENEMENT DETAILS
Tenements subject to the changeState ‘all’ if relevant to all tenements of the EGS
Tenement Tenement Holder
REC-EC-132D Rev 1 Page 1 of 2
CHECKLIST TO CONFIRM WHETHER OR NOT A REVISED MINING PROPOSAL IS REQUIRED
Yes/No Explanation/Justification
Is disturbance proposed outside of the disturbance envelope in the approved mining proposal (e.g. a project expansion)?Do any aspects of any ‘Key Mine Activities' detailed in the approved Mining Proposal need to change?Is a new activity or change to an activity type proposed from that approved in the Mining Proposal?
Corporate Endorsement: “I hereby certify that to the best of my knowledge, the information within this form is true and correct”
Name: ________________________ Signed: ______________________
Position: ______________________ Date: ________________________
REC-EC-132D Rev 1 Page 2 of 2