1.1.2. Adresa sídla znečišťovatele a další doplňující údaje
+--------------+----------------------------+--------------+----------------------------+
| Ulice | | Tel. | |
+--------------+----------------------------+--------------+----------------------------+
| č. p. | | Fax | |
+--------------+----------------------------+--------------+----------------------------+
| Obec | | e-Mail | |
+--------------+----------------------------+--------------+----------------------------+
| PSČ | | IČ | |
+--------------+----------------------------+--------------+----------------------------+
| Obec | | DIČ | |
| s roz. p. | | | |
+--------------+----------------------------+--------------+----------------------------+
| Kraj | | Sídlo fin. | |
| | | úřadu | |
+--------------+----------------------------+--------------+---+---+---+---+---+---+----+
| OKEČ | | | | | | |
+--------------+---+---+---+---+---+---+