FORM - I

[See rules 3(b), 5(2) (3) and (6) (ii)]

Application for Obtaining Authorisation for Collection/ Reception/ Treatment/ Transports/ Storage/ Disposal of Hazardous Waste

[Substituted by G.S.R. 380 (E) dated 31-3-92]

From: ………………

……………….

……………….

To

The Member Secretary,

.............…. Pollution Control Board,

………………………………………

………………………………………

………………………………………

Sir,

I / We hereby apply for authorisaiton./ renewal of authorisaiton under sub-rule (2) and (3) and clause (ii) of subrule (b) of Rule 6 of the Hazardous Wastes ( Management and Handling ) Rules, 1989 for collection/ reception/ treatment/ transport/ storage/ disposal of hazardous wastes.

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For Office Use Only

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1. Code No.

2. Whether the unit is situated in a critically polluted area as identified by Ministry of Environment and Forests;

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To be filled in by Applicant

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PART - A

General

3.(a)Name and address of the unit and location of activity

(b)Name and address of the unit and location of activity

(c)Authorisation required for ( Please tick mark appropriate activity /activities:

(i) collection.

(ii) reception.

(iii) treatment.

(iv) transport.

(v) storage.

(vi) disposal.

(d) In case of renewal of authorisation previous authorisation number and date.

4.(a) Whether the unit is generating hazardous waste as defined in the Hazardous wastes (Management Rules, 1989;

(b) If so the category No.

5.(a) Total capital invested on the project:

(b) Year of commencement of production:

(c) Whether the industry works general/ 2 shifts/ round the clock

6. (a) List and quantum of products and by-products:

(b) List and quantum of raw material used:

7. Furnish a flow diagram of manufacturing process showing input and output in terms of products and waste generated including for captive power generation and demineralised water.

PART - B

Pertaining to Sewage and Trade Effluent

8.Quantity and source of water for:

(a) Cooling m3/d

(b) Process m3/d

(c) Domestic use m3/d

(d) Others m3/d

9.Sewage and trade effluent discharge

(a) Quantum of discharge m3/d :

(b) Is there any effluent treatment plant:

(c) If yes, a brief description. of unit operations with capacity

(d) Characteristics of final effluent pH:

Suspended solids

Dissolved solids

Chemical Oxygen Demand (COD)

Biochemical Oxygen Demand BOD5/ 200C

Oil and grease

( additional parameters as specified by the concerned Pollution Control Board)

(e) Mode of disposal and final discharge point:

(enclose map showing discharge point):

(f) Parameters and Frequency of self monitoring:

[*] Read BOD (3 days at 27C) vide G.S.R. 176(E) dated 2.4.96.

PART - C

Pertaining to Stack (Chimney) and Vent Emissions

10.(a) Number of stacks and vents with height and dia (m):

(b) Quality and quantity of stack emission from each of the above stacks-particulate matter and Sulphar dioxide ( SO₂) ( Additional parameters as specified by the concerned Pollution Control Board):

(c) A brief account of the air pollution control unit to deal with the emission:

(d) Parameters and Frequency of self monitoring:

PART - D

Pertaining to Hazardous Waste and Hazardous Chemical

11.Solid Wastes:
(a) Total Quantum of generation
(b) Quantum of hazardous waste generated and its nature, as defined under Environment (Protection) Act, 1986, (see the Hazardous Wastes Management and Handling Rules, 1989):
(c) Mode of storage within the plant, method- of disposal and any other information sought by the concerned Pollution Control Board:

12.(a) Hazardous Chemicals as defined under Environment (Protection Act. 1986 (see the Manufacture, Storage and import of Hazardous Chemicals Rules, 1989):

(b) Whether any isolated storage is involved if yes, attach details Yes/NO

PART - E

Pertaining to Treatment, Storage & Disposal Facility

13.Detailed proposal of the facility ( to be attached ) to include:

(a)Processing of Waste

(i) Location of site

(ii) Name of waste processing technology

(iii) Details of processing technology

(iv) Quantity of waste to be processed per day

(v) Site clearance (from local authority, if any)

(vi) Utilization programme for waste processed (Product Utilization)

(vii) Measures to be taken for prevention and control of environmental pollution including treatment of leachates

(viii) Investment on Project and expected returns

(ix) Measures to be taken for safety of workers working in the plant

(b)Disposal of Waste

(i) Method of disposal (details in brief be given)

(ii) Quantity of waste to be disposed per day

(iii) Nature and composition of waste

(iv) Methodology and operational details of landfilling/ incineration

(v) Measures taken to check environmental pollution.

Place: Signature:

Date:Designation: