FORM - 3 [See Rule 9(1)] Format for maintaining records of hazardous waste 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: 3. Description of hazardous waste: Physical form with description Chemical form Total volume and weight (in kg.) 4. Description of storage and treatment of hazardous waste: Date Method of storage of hazardous wastes Date Method of treatment of hazardous wastes 5. Details of transportation of hazardous waste: Name & address of consignee of package Mode of packing/of the waste for transportation Mode of transportation to site of disposal Date of transportation 6. Details of disposal of hazardous waste: 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 7. Data of environmental surveillance: Date of mea-surement Analysis of ground water Analysis of soil samples Analysis of air sampling Analysis of any other samples (give details) Location of sampling Depth of sampling Data Location of sampling Depth of sampling Data Location of sampling Data 8. Details of the hazardous wastes reused and recycled: Date Total quantity of hazardous waste generated Details of hazardous waste minimization activity Material received Net reduction in waste generation quantity and percentage Final quantity of waste generated Place: Signature: Date: Designation:
