From :……………………………………. ....................................................... To The Member Secretary, Central pollution Control Board, .................................................. ......................................……… Sir, I/We hereby apply for Consent/Renewal of Consent under Section 21 of the Air (Prevention and Control of Pollution) Act, 1081 (14 of I981) to bring into use a new/ altered *stack for the discharge of emission/to begin to like new discharge of emission/ to continue to discharge emission* from stack in industry owned by………………………………………….. For Office Use Only 1. Code. No 2. Whether the unit is situated in a critically polluted area as identified by Ministry of Environment & Forests To Be Filled in by Applicant Part A - General 3. (a) Name of Owner/Occupier (b) Name and address of the unit and location 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/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 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)/ 20 C Oil and grease 200C (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 Part C –Pertaining to stack and vent emissions 10. (a) Number of stacks and vent,, with height and dia (m) (b) Quality and quantity of stack emission from each of the above stackspartculate matter and Sulphur 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 the Environment (Protection) Act, 1986. (See the Hazardous Wastes Management and Handling Rules, 1989). (c) Mode or 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 in evolved if yes, attach details Yes/No (c) Whether emergency plans are prepared for taking -On site measures Yes/No -Offsite measures Yes/No I/ We enclose herewith Cash Receipt No……………….Bank draft No…………………….. Dated…………………for Rs…………………………. (Rupees……………) in favour of the Central Pollution Control Board, New Delhi towards the fees payable under Section 25 of the Act. Yours faithfully, Name and Signature of applicant Notes : 1. Any applicant knowingly giving incorrect information or suppressing any information pertaining thereto shall be liable to be punished under the Act. 2. 2. *Strike out which is not relevant.]
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