Application for obtaining authorisation for collection / reception / treatment / transport / storage / disposal of hazardous wastes

FORM – I

[ See rules 5 (3) and (7)]

APPLICATION FOR OBTAINING AUTHORISATION

FOR COLLECTION / RECEPTION / TREATMENT / TRANSPORT / STORAGE / DISPPOSAL OF HAZARDOUS WASTE *

From	:
To,
	The Member Secretary, ………….. Pollution Control Board ………….. Pollution Control Committee            ………………………………………,

Sir,

            I / We hereby apply for authorisation / renewal of authorisation under sub-rule   (3) of Rule 5 of the Hazardous Waste (Management, Handling and Transboundary Movement ) Rules, 2008 for collection / reception / treatment / transport / storage / disposal of hazardous waste.

For Office Use Only

5.	Code No	:
6.	Whether the unit is situated in a critically polluted area as identified by Ministry of Environment and Forests	:

To be filled in by Applicant

Part A : General

3.	(a)	Name and address of the unit and location of activity	:
	(b)	Authorisation required for  ( Please tick mark appropriate activity / activities) :
		i)  Collection	:
		ii) Reception	:
		iii)Treatment	:
		iv)Transport	:
		v)  Storage	:
		vi) Disposal	:
	(c)	In case of renewal of authorization previous  authorisation number and date	:

* delete whichever is not applicable

4.	(a)	Whether the unit is generation hazardous waste as defined in these  Rules	:
	(b)	If so the type and quantity of wastes ( in Tonnes / KL. )	:
5.	(a)	Total capital invested on the project ( in Rupees)	:
	(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 by-products ( in Tonnes / KL)	:
	(b)	List and quantum of raw material used (in Tonnes / KL)	:
7.	Furnish a flow diagram of manufacturing process showing input and output in terms of products, waste generated including for captive power generation and demineralised water.

Part B: Hazardous Waste

8.         Hazardous Wastes:

(a)	Type of hazardous wastes generated as defined under these Rules	:
(b)	Quantum of hazardous waste generated	:
(c)	Sources and waste characteristics (Also Indicate wastes amenable to recycling, re-processing and reuse)	:
(d)	Mode of storage within the plant, method of disposal and capacity ( provide details)	:

9.       Hazardous Wastes generated as per these Rules from storage of hazardous chemicals as defined  

       under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989.

Part C : Treatment, Storage and Disposal Facility

10.  Detailed proposal of the facility (to be attached ) to include :

(i)	Location of site (provide map)	:
(ii)	Name of waste processing technology	:
(iii)	Details of processing technology	:
(iv)	Type and Quantity of waste to be processed per day	:

(v)	Site clearance (from local authority, if any )	:
(vi)	Utilization programme for waste processed ( Product Utilization )	:
(vii)	Method of disposal (details in brief be given )	:
(viii)	Quantity of waste to be disposed per day	:
(ix)	Nature and composition of waste	:
(x)	Methodology and operational details of land filling / incineration	:
(xi)	Measures to be taken for prevention and control of environmental pollution including treatment of leachate	:
(xii)	Investment on Project and expected returns	:
(xiii)	Measures to be taken for safety of workers working in the plant	:

Place:                                                                                      Signature    : ………………

Date  :                                                                                     Designation:………..............