注意：本文件为私人翻译，非官方英文版，可能存在表述不当，仅供参考。
Appendix 2
Environmental impact declaration (Registration) form for construction projects
(Industrial)
Project name__________________________ ___ __ Construction organization (Seal)___________________
Date of compilation：（y）（m）（d）
Made by Environmental Protection Department of Jiangsu province
一、Basic situation of construction projects
二、The project plans to construct the map of the environment around the address (if the whole plant is not occupied, the upper and lower level enterprises must be noted) and the distribution of the
三、Project process and environmental impact analysis (If the table is
not enough, please attach the page)
声明：
本人郑重声明：本表以上所填报资料完全属实，如存在瞒报、假报等情况及由此导致的一切后果由本人承担全部责任。
项目法人代表（签字）：
（注：委托签名须附委托书）
年月日
