FORM - 12

[See rule 19 (xiii)]

Form for Filling Recyclers Non-Ferrous Metal Wastes/ Used Oil

[To be submitted by recyclers to State Pollution Control/ Committee by 30th June and 31st December of every year]

1. Name and address of the recycler
2. Name of the authorised person and fall address with telephone and fax number
3. Installed annual capacity to recycle non-ferrous metal wastes/ used oil ( in MTA )
4. ( in MTA ) purchased/ processed/ sold during the

period from October - March / April -September

(i) Quantity of wastes purchased from the manufactures-

(ii) Quantity of wastes purchased from auctioneers-

(iii)Quantity of wastes obtained form any other source-

(iv)Quantity of wastes processed-

(v) Quantity of wastes sold

5. Quantity and type material recovered from nonferrous metal wastes/ used oil ( in MTA)
6. Quantity of recycles materials sent back (i) the manufacturers

(ii) other agencies #

*delete whichever is not applicable

#enclose list of other agencies

Signature of the authorised person

Place:…………………..

Date:………………….