Sr. No. Rs.25/-
Form-I
[ See Rule 3(b) 5(2), (3) and (6) (ii)]
APPLICATION FOR AUTHORISATION/RENEWAL OF AUTHORISATION FOR COLLECTION/ RECEPTION/TREATMENT/ TRANSPORT/ STORAGE/ DISPOSAL OF HAZARDOUS WASTES.
From
__________________________
__________________________
__________________________
To
The Member Secretary,
Himachal Pradesh State Environment Protection & Pollution Control Board,
Paryavaran Bhawan, Phase-III, Shimla-171009.
Sir,
I/ We apply fro authorisation /Renewal of Authorisation under
sub-rule (3) of Rule 5 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.:
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2. |
Whether the unit is situated in a critically Polluted area as identified by Ministry of Environment & Forests:
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TO BE FILLED BY
APPLICANT
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PART A-GENERAL: |
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3. |
(a) |
Name of Owner/Occupier: |
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(b) |
Name and address of the unit and location of activity:
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(c) |
Authorisation required for (Please tick mark appropriate activity/activities) (i) Collection. (ii) reception (iii) Treatment. (iv) Transport. (v) Storage. (vi) Disposal. |
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(d) |
In case of Renewal of authorisation, previous Authorization Number and date. |
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4. |
(a) |
Whether the unit is generating the hazardous waste as defined in the Hazardous Wastes ( Management & Handling) Rules, 1989 and amendments made thereunder, |
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(b) |
If so type and quantity of waste. |
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5. |
(a) |
Total capital invested on the project: |
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(b) |
Year of commencement of production: |
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(c) |
Whether the industry works general/ 2 shifts/ round the clock: |
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6. |
(a) |
List and quantum of products and bye-products: |
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(b) |
List and quantum of raw materials used: |
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7. |
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Furnish a flow diagram of manufacturing process input and output in terms of products and waste generated including for captive power generation and demineralised water:
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PART B -PERTAINING TO SEWAGE AND TRADE EFFLUENT: |
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8. |
Quantity and source of water for, |
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(a) |
Cooling m3/d. |
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(b) |
Process m3/d. |
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(c) |
Domestic use m3/d |
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(d) |
Others m3/d. |
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Place: Signature Date: Designation
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9. |
Sewage and trade effluent discharge: |
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(a) |
Quantum of discharge m3/d. |
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(b) |
Is there any effluent treatment plant. |
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(c) |
If ‘yes’, a brief description of unit operations with capacity. |
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(d) |
Characteristics of final effluent-pH. |
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Suspended solids. Dissolved solids. Chemical Oxygen Demand (COD). Biochemical Oxygen Demand (BOD5// 20ºC/ BOD3// 27ºC Oil and grease. (Additional parameters as specified by the concerned Pollution Control Board). |
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(e) |
Mode of disposal and final discharge point (Enclose map showing discharge point. |
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(f) |
Parameters and frequency of self-monitoring.
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PART C-PERTAINING TO STACK (CHIMNEY) & VENT EMISSION: |
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(a) |
Number of stacks and vents with height and dia (m). |
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(b) |
Quality and quantity of stack emission from each of the above stacks-particulate matter and Sulphur Dioxide (SO2) (Additional parameters as specified by the concerned Pollution Control Board). |
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(c) |
A brief account of the air pollution control unit to deal with the emission. |
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(d) |
Parameters and frequency of self-monitoring. |
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PART D - PERTAINING TO HAZARDOUS WASTE AND HAZARDOUS CHEMICALS: |
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11. |
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Solid wastes. |
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(a) |
Total quantum of generation. |
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(b) |
Quantum of hazardous waste generated and its nature, as defined under the Environment (Protection) Act, 1986. (See the Hazardous Waste (Management and Handling) Rules, 1989. |
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(c) |
Mode of storage within the plant, method of disposal and any other information sought by the concerned Pollution Control Board. |
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12. |
(a) |
Hazardous chemicals as defined under Environment (Protection) Act 1986, (See the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989). |
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(b) |
Whether any isolated storage is involved if ‘yes’, attach details. |
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(c ) |
Whether emergency plans are prepared for taking . |
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-On –site measures.
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-Off-site measures.
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FORM-3
[See Rule 9(1)]
FORMAT FOR MAINTAINING RECORDS OF HAZARDOUS WASTES AT THE FACILITY
1. Name and address of the occupier or operator of a facility:
2. Date of issuance of authorization and its reference number:
3. Description of hazardous waste:
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Physical form with description |
Chemical form |
Total volume and weight (in kg.) |
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4. Description of storage and treatment of hazardous waste:
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Date |
Method of storage of hazardous wastes |
Date |
Method of treatment of hazardous wastes |
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5. Details of transportation of hazardous waste:
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Name and address of the consignee of package |
Mode of packing/ of the waste for transportation |
Mode of transportation to site of disposal |
Date of transportation. |
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6. Details of disposal hazardous waste:
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Date of disposal |
Concentration of hazardous material in the final waste form |
Sit of disposal (identify the location on the relevant layout drawing for reference) |
Method of disposal |
Persons involved in disposal |
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7. Data on environmental surveillance:
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Date of measurement |
Analysis of ground water |
Analysis of soil samples |
Analysis of air sampling |
Analysis of any other samples (give details) |
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Location of sampling |
Depth of sampling |
Data |
Location of sampling |
Depth of sampling |
Data |
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