COOLING TOWER AND REGULATED SYSTEM REGISTRATION FORM

The Public Health Regulation 2022 requires that all regulated systems including cooling towers and warm water systems installed in the Canterbury-Bankstown Local Government Area be registered with City of Canterbury Bankstown Council. This registration form is to be used by owners/operators in order to register their regulated system/s, change any registration details or to notify Council that their regulated system/s have been decommissioned.

If you have any questions in regards to this form, please contact Council’s Public Health Unit on 9707 9000.

Cooling tower/regulated system details

Submission details *

New system registration Update registration detailsDecommission

Date installed *

Building/shopping centre name *

Address *

Business/occupier's details

Business/trading name *

ABN *

Company name *

Contact person *

Contact phone number *

Email *

Postal address *

After hours contact details

Contact *

Number *

Position

System details

Type *

Cooling towerWarm waterOther

Location *

RoofGroundPlant room

Specify other

Make/model *

Number of systems *

Number of cooling towers per system *

Water treatment company details

Business/company name *

Contact name *

Contact number *

Privacy statement

In submitting this form, you consent to Council:

1. Collecting your personal information as contained in the form; and

2. Using the information for the purposes outlined in the form and for any other Council function.

Providing your information is voluntary. Should you choose not to provide the information, Council is unable to process yourapplication/request.

You may access any of your personal information that Council holds upon request.

Applicant declaration

I declare that to the best of my knowledge, the information provided in this registration form is accurate and correct.

Owner name *

Date *

Signature *

Draw signature|Type signatureClear

Note: A notification fee of $120.00 (incl. GST) is applicable when you register a cooling tower with Council. An invoice will be mailed to the above supplied mailing address, following receipt of your registration form. In addition to an invoice, Council will also issue an identification tag with a unique identification number to be affixed to each cooling tower.

If you have any questions in regards to this form, please contact Council’s Public Health Unit on 9707 9000.