Accounts
Officer Member Secretary
Chairman
FORM
X
REPORT
BY THE CENTRAL BOARD ANALYST
(See
Rule 26)
Report
No.
Dated
the 19
I
hereby certify that I, (I) ......................................................
Central Board analyst duly appointed under sub-section (3) of section 53 of
the Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) received
on the (II) ............................ day of ......................19 ...............from
(III) .............................. a sample of .............. for analysis.
The sample was in a condition fit for analysis reported below:
I
further certify that I have analysed the aforementioned sample on (IV) .................................
and declare the result of the analysis reported below.
I
further certify that I have analysed the aforementioned sample on (IV) ..........................
and declare the result of the analysis to be as follows : -
(V)
.....................................................................................................................................................
The
condition of the seals, fastening and container on receipt was as follows:
-
...................................................................................................................................................................
signed
this ..................................................day of............................................19........................................
(Signature)
(Central
Board analyst)
Address
................................................
To
-----------------------------------------
-----------------------------------------
-----------------------------------------
(I)
Here write the full name of the Central Board analyst.
(II)
Here write the date of receipt of the sample.
(III)
Here write the name of the Board or person or body of persons or officer from
whom the sample was received.
(IV)
Here write the date of analysis.
(V)
Here write the details of the analysis and refer to the method of analysis.
lf the space is not adequate the details may be given on a separate sheet
of paper.
FORM
XI
REPORT
BY THE GOVERNMENT ANALYST
(See
Rule 27)
Report
no.
Dated
the 19
I
hereby certify that I, (I) ...............................................
Government analyst duly appointed under sub-section (1) of section 53 of the
Water (Prevention and Control of Pollution) Act, 1974 (6 of 1974) received
on the (II) ............................ day of ..............19 ...........from
(III) ................................... a sample of ..........................
for analysis. The sample was in a condition for analysis reported below :
I
further certify that I have analysed the aforementioned sample, on (IV) .............................
and declare the result of the analysis to be as follows:-
(V)......................................................................................................................................................
...........................................................................................................................................................The
condition of the seals, fastening and container on receipt was as follows:-
..............................................................................................................................................
signed
this ...........................................................day of .................................19
..................................
(Signature)
(Government
analyst)
Address.
To------------------------------
--------------------------------
--------------------------------
(I)
Here write the full name of the Government analyst.
(II)
Here write the date of receipt of the sample.
(III)
Here write the name of the Board or person or body of persons or officer from
whom the sample was received.
(IV)Here
write the date of analysis.
(V)
Here write the details of the analysis and refer to the method of analysis.
If the space is not adequate and details may be given on a separate sheet
of paper.
FORM
XII
CENTRAL
POLLUTION CONTROL BOARD
Notice
of intention to have sample analysed
(See
Rule 31)
To
Take
notice that it is intended to have analysed the sample of water/sewage effluent/trade
effluent which is being taken today the ....................... day of .....................
19 .......... from (I)
Name
and designation of the person
who
takes the sample
(I)
Here specify the stream, well, plant vessel or place from where the sample
is taken.
To.-----------------------
--------------------------
--------------------------
2)1FORM
XIII
Application
for consent for establishing or taking any steps for establishment of Industry
operation process or any treatment disposal system for discharge, continuation
of discharge under section 25 or section 26 of the Water (Prevention and Control
of Pollution) Act, 1974.
(See
Rule 32)
From-----------------------------
Date
------------------------------------
------------------------------------
To
The
Member Secretary,
Central
Pollution Control Board.
Sir,
I/We
hereby apply for Consent/Renewal of Consent under section 25 of the Water
(Prevention and Control of Pollution) Act, 1974 (6 of 1974) for establishing
or taking any steps for establishment of Industry/operation process or any
treatment/disposal system to bring into use any new/altered outlet for discharge
of *sewage/trade effluent* to continue to discharge* sewageltrade effluent*
from land/premises owned by.............................
The
other relevant details are below:-
1.
Full Name of the applicant
2.
Nationality of the applicant
3
(a)Individual
(b)
Proprietory concern
(c)
Partnership firm
(whether
registered or unregistered)
(d)Joint
family concern
(e)Private
Limited Company
(f)Public
Limited Company
(g)Government
Company
(1)
State Government
(2)
Central Government
(3)
Union Territory
(h)
Foreign Company
(if
a foreign company, the details of registration, incorporation, etc.)
(i)Any
other Association or Body :
4.
Name, Address and Telephone Nos. of Applicant. (the full list of individuals,
partners, persons, Chairman (full-time or part-time Managing Directors, Managing
Partners, Directors (Full time or part-time) other kinds office bearers are
to be furnished with their period of tenure in the respective office, with
telephone Nos. and address).
5.
Address of the Industry
(Survey
No., Khasra No., location as per the revenue records. Village Firka, Tehsil
District, Police Station or SHO, jurisdiction of the First-Class Magistrate).
6.Details
of commissioning etc.:
(a)
Approximate date of proposed commissioning of work.
(b)
Expected date of production :
7.Total
number of employee expected to employed.
8.Details
of licence, if any obtained under the provisions of Industrial Development
Regulations Act, 1951.
9.Name
of the person authorised to sign this form (the original authorisation except
in the case of individual proprietary concern is to be enclosed).
10.(a)
attach the list of raw materials and chemicals used per month.
(b)
Licence Annual Capacity of the Factory/Industry.
11.State
daily quantity of water in kilolitres utilised and its source (domestic/ industrial
process boiler Cooling others).
12.
(a) State the daily maximum quantity of effluents quantity and mode of disposal
(sewer or drains or river). Also attach analysis report of the effluents.
Type of effluent quantity in kilolitres, Mode of disposal.
(i)Domestic
(ii)Industrial
(b)
Quantity of effluent currently being the discharged or expected to be discharged.
(c)
What monitoring arrangement is currently there or proposed.
13.State
whether you have any treatment plant for industrial, domestic or combined
effluents.
Yes/No
If
yes, attach the description of the process of treatment in brief. Attach information
on the qualityof
treated
effluent vis-a-vis the standards.
14.State
details of sold wastes generated in the process or during waste treatment.
Description
Quantity
Method
Method of disposal.
15.I/We
further (declare that the information furnished above is correct to the best
of my/our knowledge.
16.I/We
hereby submit that in case of change either of the point of discharge or the
quantity of discharge or its quality a fresh application for CONSENT shall
be made and until such CONSENT is granted no change shall be made.
17.
I/We hereby agree to submit to the Central Board an application for renewal
of consent one month in advance of the date of expiry of the consented period
for outlet discharge if to be continued thereafter.
18.
I/We, undertake to furnish any other information within one month of its being
called by the Central Board.
19.I/We,
enclose herewith cash receipt No./bank draft No. ...................... dated
.................... for
Rs........................................................................................(Rupees...................................................
...........................................................................
) in favour of the Central Pollution Control
Board,
New Delhi, as fees payable under section 25 of the Act.
Yours
faithfully.
signature
of the applicant
Note:
* Strike out which is not relevant.
FORM
XIV
CENTRAL
POLLUTION CONTROL BOARD
NOTICE
OF INSPECTION
[See
Rule 33(2)]
Chairman
Member Secretary
Shri
Shri-------------------------------------------------
------------------------------------------------------
No.-------------------------------------------------
Dated----------------------------------------------
To
TAKE
NOTICE that for the purpose of enquiry under sections 25/26 the following
officers of the Central Board namely
(i)
Shri------------------------------------------------------------------
(ii)
Shri----------------------------------------------------------------
(iii)
Shri---------------------------------------------------------------
and
the persons authorized by the Board to assist them shall inspect the
(a)
Water works
(b)
Sewage works
(c)
Waste treatment Plant
(d)
Factory
(e)
Disposal system
(f)
Any other parts thereof or pertaining thereto under management/control on
date(s) ............................... between ...................... hours,
when all facilities requested by them for such inspection should be made available
to them on the site. Take Notice that refusal or denial to above stated demand
made under the functions of the Central Board shall amount to obstruction
punishable under section 42 of the Act.
By
order of the Board
Member-Secretary
Copy
to:
1.
-----------------------
2.
----------------------
3.
---------------------
SCHEDULE
II
BUDGET
AND ACCOUNT HEADS
[See
Rule 15(3)]
ADMINISTRATION
Heads
of Accounts (Expenditure)
1.
Salaries.
2.
Wages.
3.
Travel expenses.
4.
Office expenses.
(c)
Office machines equipment
(d)
Liveries.
(c)
Hot and cold weather charges.
(f)
Telephones.
(g)
Electricity and water charges
(h)
Stationery.
(i)
Printing.
(j)
car and other vehicles.
(k)
Other items.
5.
Fee and honoraria.
6.
Payment for professional and special services.
7.
Rents, rates and taxes/royalty.
8.
Publications.
9.
Advertising sales and publicity expenses.
10.
Grants in aid/contributions/subsidies.
11.
Hospitality expenses sumptuary allowances etc.
12.
Pensions/gratuities.
13.
Write off/losses.
14.
Suspense.
15.
Expenses in connection with the setting up and maintenance of the Board laboratory.
16.
Other charges (a residuary head, this will also include rewards and prizes).
Heads
of Account (Receipts)
1.
Payments by Central Government.
2.
Fees.
3.
Fines and other receipts.
(1) [SCHEDULE III
(See
Rule 16)
CENTRAL
POLLUTION CONTROL BOARD
ANNUAL
REPORT FOR THE FINANCIAL YEAR
APRIL
1, 19 ... TO MARCH 31, 19 ...
Chapter-1
Introduction
Chapter-2
Constitution of the Board including changes therein.
Chapter-3
Meeting of the Board with major decisions taken therein.
Chapter-4
Committees constituted by the Board and their activities.
Chapter-5
Monitoring Network for air, water and soil quality.
Chapter-6
Present state of environment, environmental problems and counter measures.
Chapter-7
Environmental Research.
Chapter-8
Environmental Training.
Chapter-9
Environmental Awareness and Public-Participation.
Chapter-10
Environmental Standards including time schedule for their enforcement
Chapter-11.1
Prosecutions launched and convictions secured for environmental pollution
control.
Chapter-11.2
Directions given for closure of polluting industrial units.
Chapter-12
Finance and accounts of the Board.
Chapter-13
Annual Plan of the following year.
Chapter-14
Any other important matter dealt with by the Central Board.
ANNEXURES
1.
Members of the Board.
2.
Organisation Chart.
3.
Staff Strength including recruitment.
4.
Publications.
5.
Training Courses/Seminars/Workshops organised or attended.
6.
Consents to establish industries, operations & processes - issued/refused
7.
Consents to operate industries operations & process - issued/refused.
[F.
No. Z-20013/4/91-CPW]
MUKUL
SANWAL, jt. Secy.
(3)1Schedule
IV
(See
rule 28)
Rates
of fees payable in respect of a report of the Central Water Laboratory