FORM I (See rule 3(b) 5(2), (3) and (6) (ii)] Application for authorisation/renewal of authorisation for collection/reception/treatment/ transport/storage/ disposal of hazardous wastes From: To 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. 1. Code No. : 2. Whether the unit is situated in a critically polluted area as identified by Ministry of Environment & Forests Part A - General 3. (a) Name of 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 (d) 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 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 or FOR OFFICE USE ONLY TO BE FILLED IN BY APPLICANT 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 (BOD) : Oil and grease : (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 (Chimney) And Vent Emissions 10. a) Number of stacks and vents with height and diameter (m) b) Quality and quantity of stack emission from each of the above stacksparticulate matter Sulphur Dioxide (SO 2) (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 Chemicals. 11. Solid wastes: a) Total quantum of generation : b) Quantum of hazardous waste generated and : Vas defined under the Environment Act, 1986. (See the Hazardous Wastes 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 Environment (Protection) Act, 1986 (See 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 FORM 3 [See rule 9(1)1 Format for maintaining records of hazardous wastes at the facility 1. Name and address of the occupier or operator of a facility: 2. Date of issuance of authorisation and its reference number: Description of hazardous waste: 4. Description of storage and treatment of hazardous waste: 5. Details of transportation of hazardous waste: Name and address of the consignee of package Mode Of packing/of the waste for transportation Mode of transportation to site Of disposal Date of transportation Date Method of storage of hazardous wastes Date Method of treatment of hazardous wastes 6. Details of disposal of hazardous waste: 7. Data on environmental surveillance: Date of disposal Concentration of hazardous material in the final waste form Site Of disposal (identify the location on the relevant layout drawing for reference) Method of disposal Persons involved in disposal Date of Analysis of any measure- Analysis of ground water Analysis of soil samples Analysis of air sampling other samples(give ment details) Location of sampling Depth of sampling Data Location of sampling Depth of sampling Data Location of sampling Data Name and signature of the Head of facility FORM-4 (See Rule 9(2)] Format for the submission of returns, regarding disposal of hazardous waste (To be submitted to the Stale Pollution Control Board) 1. Name and address of the Institution: 2. Details of waste disposal operations: Sl. No. Date of issuance of authorisation for the disposal of hazardous waste and its references number Description of Hazardous Waste 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(Total Volume of the hazardous waste disposed with No. of packages if any) Physical form and contents Chemical form Name and signature of the Head of the Facility FORM - 7 See rule -13 (5) 4. (6) 1 Transboundary Movement of Waste Notification 8. Waste generator (s)(Name, address) (2): 12. (i) Designation and complete chemical composition o f waste(attach details) Contact Person Tel.: (it) Special handling requirements Fax/Telex Site of generation & Process: 13. Physical characteristics (4): 14. Waste identification code 16. Y-number (4): Basel No: OECD No.: UN No. : ITC (HS) 17. H-number (4): Customs code (H.S.): Other (specify): I 15, OECD classification (1): amber. E] Red [ ] and number: 18.(i) UN identification N2 (ii) UN class (4): Other [ ] UN shipping name: * (attach details) 19. Concerned states, code number of competent authorities, and specific points of entry and exit: State of export States of transit State of import 20. Customs Aces of entry and/or departure 2 1. Exporter's/Generator's declaration: Entry: I certify that the information is complete and Correct to my best knowledge. I also certify that Departure Legal y-enforceable written contractual obligations have been entered into and that any applicable insurance or other financial guarantees are or shall be (1) Enter X in appropriate box (2) Attach list if more than one (3) Attach detailed list of multiple shipment (4) See codes on the reverse List of abbreviations used in the Movement Document RECOVERY OPERATIONS (Block 9) R I Use as a fuel (other than in direct incineration) or other means to generate energy R2 Solvent reclamation/regeneration R3 Recycling/reclamation of organic substances which are not used as solvents R4 Recycling/reclamation of metals and metal compounds R5 Recycling/reclamation of other inorganic materials R6 Regeneration of acids or bases R7 Recovery of components used for pollution abatement R8 Recovery of components from catalysts R9 Used oil re-refining or other reuses of previously used oil RIO Land treatment resulting in benefit to agriculture or ecological improvement R11 Uses of residual materials obtained from any of the operations numbered R I to 10 R12 Exchange of wastes for submission to any of the operations numbered RI to R I I R13 Accumulation of material intended for any operation numbered RI to RI 2 MEANS OF TRANSPORT PACKAGING TYPES (Block 16) H NUMBER AND LIN CLASS (Block 17) (Block 8-10) R = Road 1. Drum LIN Class H No. Designation 2. Wooden barrel T = Train/Rail 3. Jerrican I H I Explosive 4. Box 3 H3 Inflammable liquids S = Sea 5. Bag 4.1 H4.1 Inflammable solids 6. Composite packaging 4.2 H4.2 Substances or wastes liable to Air A= Air 7. Pressure receptacle spontaneous com bustion 8. Bulk 4.3 H4.3 Substances or wastes which, in W W= Inland Waterways 9. Other (specify) contact with water emit inflammable gases The country on: Entry Departure Entry Departure Stamp: Signature: FORM 7A [ See rule - 12 (5) & 14(4) ] Transboundary Movement of Waste Movement Document (1) Attach list, if more than one (2) Enter X in appropriate box (3) See codes on the reverse (x) Immediately cont act Competent Authority. (4) If more than three carriers, attach information as required in blocks 6 and 11. List of abbreviations used in the notification Y numbers (block 16) refer to categories of waste listed in Annex I and II of the Basel Convention, as well as more detailed information can be found inan instruction Manual available from the Secretariat of the Basel Convention. . 25. SPECIFIC CONDITIONS ON CONSENTING TO THE MOVEMENT
