FORM-4 [ See rule9(2)] Form For Filing Returns Regarding Handling Of Hazardous Wastes [ To be submitted to the State Pollution Board/Committee by 31st January of every year] 1. Name and address of the Occupier/Operator of Facility: 2. Categories of Waste generated and quantity (in metric tones): 3. Details of Waste treatment operations: 4. Details of Waste disposal operations: Sr No. Date of issuance of authorization for the disposal of hazardous waste and its reference number Description of Hazardous Waste Total Volume of the hazardous waste disposed with No. of Packages Mode of Transportation to the site of disposal Site of disposal (attach a sketch showing the location(s) of disposal) Brief description of the method of disposal Date of disposal Remarks (if any) Physical Form and Contents Chemical Form 5. Details of environmental surveillance: Date of other measurement details Analysis of ground water samples Analysis of soil sample Analysis of air sampling Location of sampling Depth of Sampling Data Sampling Location of sampling Depth of Sampling Data Sampling Location of sampling Data Sampling Analysis of any samples (give details) Date: Signature......... Place: Designation........
