APPLICATION FOR REGISTRATION AS ACTUAL USER AND FACILITIES FOR ENVIRONMENTALLY SOUND MANAGEMENT OF HAZARDOUS WASTE REPROCESSING (To be submitted in triplicate to the Ministry of Environment & Forests, Hazardous Substances Management Division, Paryavaran Bhawan, CGO Complex, Lodi Road, New Delhi-110003) 1. Name & Address of the unit : 2. Contact Person: With designation, Tel/Fax No : 3. Date of Commissioning : 4. No of Workers (including : contract Labourers) 5. Consent validity : Air act 1981,valid up to: Water Act 1974 Valid up to 6. Authorisation under Rule 5 of the : HW (M &H) Rules, 1989 7. Product manufactured (Tonnes/year) Name 1998-99 1997-98 1996-97 8. Raw material consumption: (Tonnes/year) Name 1998-99 1997-98 1996-97 9 . Manufacturing process: Please attach manufacturing process flow diagram for each product(s): 10. Water Consumption Industrial. m3 /day Domestic. m3 /day 11. Water cess paid up to : 12. Waste water generation : Industrial domestic a) as per consent, m3/day : b) actual m3 /day : (last three months average) 13 Waste water treatment : Industrial (please provide flow diagram of : Domestic the treatment scheme) 14. Waste water discharge : Quantity --m3 /day Location: Analysis of treated waste water 15. Air pollution control (A) Please provide flow diagram for Emission control system(s) installed for each process unit, utilities, etc. (B) Details of facilities provided for control of fugitive emission due to material handling, process utilities etc Fuel consumption : Sl. No. Name Quantity/dayor month Stack emission monitoring results : Sl. No. Stack Emission, mg/Nm3 Ambient air quality : Sl. No. Location Parameters, 16. Hazardous waste management Sl. No. Name Quantity (last 3 yrs) (A) Waste generation : (B) Details on collection, treatment and transport : (C ) Disposal (i) Please provide details of the disposal facilities (ii) Whether facilities provided are in compliance of the conditions stipulated in the Authorisation under Rule 5 by the SPCB. (iii) Please attach analysis report of characterisation of hazardous waste generated(including leachate test if applicable) 17. Details of waste required through auction or import, as the case may be 1. Name 2. Quantity required per year for use as raw material 3. Position in List A/List B as per BaselConvection (BC) 4. Nature as per Annex III of BC 18.Occupational safety and health aspects Please provide details of facilities provided 19. Remarks (i)Whether industry has provided adequate pollution control system/equipment to meet the standards of emission/effluent (ii) Whether industry is in compliance with condition stipulate under authorisation(Rule 5) (iii) Whether HW collection Treatment and disposal facilities are operating satisfactorily. (iv)Whether a condition exists or is likely to exist of the material(HW) handling/processing may pose immediate or delayed adverse impacts on environment (v) Whether a condition exists or is likely to exist of the material (HW) handling/processing is capable by any means, after disposal, of yielding another material e.g. leachate which may possess ecological toxicity 20. Any other information - Date: Place: Signature Name Designation : : :
