Sorry, I should have made myself clearer.
The table as quoted is indeed from CAP 804 and takes the form of an AltMOC issued by the UK CAA. MartinCh warned that this may not be acceptable outwith the UK. Ersa stated that "the table is provided by EASA so all ATO in EASA land have to follow it".
I was simply trying to find an EASA reference rather than the UK AltMOC in order to confirm ersa's statement.