FORM 1: APPLICATION FOR AUTHORISATION/RENEWAL OF AUTHORISATION FOR COLLECTION/ RECEPTION/ TREATMENT/ TRANSPORT/ STORAGE/DISPOSAL OF HAZARDOUS WASTES Rules 3(b), 5(2), 5(3) and 5(6)(ii) From ..................... ..................... ..................... To The Member-Secretary ..................Pollution Control Board, .................................. .................................. Sir, I/ we hereby apply for 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. For office use only 1. Code No.: 2. Whether the unit is situated in a critically polluted areas as identified by the Ministry of Environment and Forests: To be filled by applicant Part A-General 3. (a) Name of the owner occupier. (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. (b) 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 and Handling) 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 1/2 shifts/ round the clock. 6. (a) List and quantum of products and bye-products, (b) List and quantum of raw materials 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 m/ d: (b) Process m/ d: (c) Domestic use m/ d: (d) Other m/ d: 9. Sewage and trade effluent discharge:- (a) Quantum of discharge m/ d: (b) Is there any effluent treatment plant: (c) If yes, a brief description of unit operation with capacity: (d) Characteristics of final effluent pH: Suspended solids Dissolved solids Chemical Oxygen Demand (COD) Bio-Chemical Oxygen Demand BOD (3 days at 27o C) Oil and grease (Additional parameters as specified by the Pollution Control Board) (e) Mode of disposal and final discharge point, map showing discharge point) (f) Parameters and frequency of self-monitoring. 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 Sulphur Dioxide (SO2). (Additional parameters as specified by the Pollution Control Board concerned) (c) A brief account of the air pollution control unit with the emissions. (d) Parameters and frequency of self-monitoring. Part D-Pertaining to hazardous wastes and hazardous chemicals: 11. Solid wastes:- (a) Total quantum of generation: (b) Quantum of hazardous waste generated and its nature, as defined under the Environment (Protection) Act, 1986 (Refer to 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 the Environment (Protection) Act, 1986 (Refer to the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989): (b) Whether any isolated storage is involved if yes, attach details: Yes/ No (c) Whether emergency plans are prepared for taking: On-site measures Yes/ No Off-site measures Yes/ No Yours faithfully Name and signature of the applicant | 