Download Application Form for Consent for Emission/Continuation of Emission under Section 21 of the Air Act

PRICE Rupees Fifty only FORM - 1 (To be submitted in triplicate) APPLICATION FOR CONSENT FOR EMISSION/ CONTINUATION OF EMISSION UNDER SECTION 21 OF THE AIR ACT. (See Rule 4) From Date ......... ............................................................................. ............................................................................. ............................................................................. ............................................................................. To The Member Secretary, Meghalaya State Pollution Control Board, 'ARDEN', Motinagar, SHILLONG- 793014. Sir I * ....................occupier of the industrial plant ** ....................hereby apply for consent under section 21 of the Air (Prevention and Control of Pollution) Act 1981 for a Period upto of _________ (not exceeding three years) to operate the above mentioned industrial plant, detail pertaining to it being given in the Annexure and the accompaniments submitted in triplicate at part of this application. 2. I declare that the information furnished in this application, annexure, accompaniments and appendixes, if any, are correct and true to the best of my knowledge and belief _____________ 3. I hereby agree to inform the Board within 15 days of any change in the particulars in respect of the occupier and/or authorised agent. 1. Form I in set of five is obtainable from the office of the Meghalaya State Pollution Control Board, Shillong on payment of Rs. 50 (Rupees fifty only) in cash or by Money Order. 2. Read the explanatory note at the end of the application form carefully before filling the form. 3. I hereby submit that in case of a change either of the point or the quality of emission or its quantity, a fresh application for consent shall be made and until such consent is granted no change shall be made. 4. I hereby agree to submit to the Board application for renewal of consent six months in advance of the date of expiry of the consented period if the operation of the industrial plant is to be continued thereafter. 5. An amount of Rs. ...........(Rupees ...............) as the consent fee for this application has been remitted in the office of the Board vide Receipt No .., Dated ......... an authenticated copy of which is attached as proof of payment. 6. I undertake to furnish any other information called for by the Board within such times as specified by the Board. Yours faithfully, Occupier's signature................................ Name ....................................................... Address ................................................... Note: * Here enter the name and address of the occupier who, in relation to any factory or the premises, is the person who has control over the affairs of the factory or the premises and where the said affairs are entrusted to a managing agent, such agent shall be deemed to the occupier of the factory or the premises. ** Here enter the name and address of the industrial plant Accompaniments: i) Index/Site plan ii) Topographical map iii) Detailed layout plan of different process and point, of emissions and position of stacks & chimneys iv) Process flow sheet v) Emission analysis report vi) Ambient air quality report, if available vii) Details of air pollution control devices provided or proposed to be provided viii) Copy of the receipt for the consent fee. ANNEXURE TO FORM - I Chimney Existing New Altered NOTE: (i) While filling this Annexure, the applicant (occupier) shall 'not applicable' against which are not pertaining to this Industrial plant and no space shall be left blank. (ii) Any applicant knowingly giving incorrect information or suppressing any information pertaining thereto shall be liable to be punished under the Act. 1) a) Full name of the occupier : b) Designation : c) Postal address : d) Telegraphic address : e) Telex/Fax No. : f) Telephone No. : 2) Full name and address of the Industry & its registered office : : 3) Name/s, designation/s and postal address of authorized agent/agents : 4) a. Type of industry (with reference to the schedule of the Act) b. Category of Industry, small scale/medium scale/ large scale. c. Capital investment (with year of investment) 5) Month and year in which the plant was actually put into commission or is proposed to be put into commision : 6) Location of the Industrial plant a. Revenue Survey No. b. Area in Hectares c. Village d. Taluk e. District f. Panchayat/Municipality/Corporation 7) a. State whether he Industry premises has been decleared a prohibited area Yes/No. b. If yes,state the name of authority making the declaration & furnish a certified copy of the declaration order. 8) a. State whether the Industry is working round the year or seasonal 9) a. Number of persons attending in the premises/the factory per day........ b. Number of persons residing in the premises.......... 10) List of individual plants in the industry 11) a. List of materials used in process (other than fuels) Sl. No. Name of material Process where used Consumption in tones/day A Process flow diagram must be attached showing the entry and exit points of all raw materials, intermediate products, by-products and products Label process and control equipments and give process description. b) Details of fuel consumption. Fuel Coal Oil Wood Gas Others Identification/commercial name a) Daily consumption in tones b) Where used c) Calorific value d) Ash content percent e) Sulphur content percent f) Others (specify) List of products and by-products Sl. No. Name Quantity in tones/day 12) a. Indicate the present use of the land within 5 Km radius, : i) Human settlements of more than 1000population (specify population and distance from the plants) : ................. ................. ii) Commercial ................. iii) Industrial .................. iv) Fisheries ................. v) Hills/mountains/sanctuary/National Parks vi) Ancient monuments vii) Worship centres b. Climatological and metrological details (if available) i) Climate condition & the site ........... (e.g. arid, semi-arid etc.) ii) Rainfall, yearly average, range .............. iii) Temperature, seasonal changes ............. iv) Speed and direction of wind ............... v) Humidity, solar radiation ................. 13. a) Details of furnaces : Ref. No. of chimney in Fuel used, quantity Operation & layout plant through Type of furnace of fuel, tonne/day Loading which emission take place b) Details of boilers : Ref. No. of chimney in Quantity Operation layout plant through Type of fuel boiler fuel tonne/ Steam Capacity and which emission take place day pressure Loading 14. a) Details of chimney : Ref. No of Chimney in lay-out plan Nature of construction Height in m Inside shape circle, square etc. Inside dimension in m diameter size etc. (specify) Qnty. m3/hour Exit Gas Above ground level Above roof level Temperature 0c C0 Velocity m/sec b) Chimney Emission Ref. of chimney Source of emission Analysis of gas * mg/m3 In layout Plan Oxides of Hydrocarbons Particulates Others S C N c) Any other emissions Source/Outlet Quantity Temperature analysis of gas * mg/m3 m3/hr 0C Oxides of Hydrocarbons Particulates Others S C N d) Particulate analysis (if available) Identification referring to 14 (b)(c) size distribution Chemical Composition 50/m/10/m/5/m//3/m/1/m * (i) Attach copy of laboratory report (ii) Specify the parameters 15. Laboratory facilities for air emission analysis Existing / Proposed 16. Quantity of air handled by ventilation equipments, specifying the number and size of equipments installed or to be installed. 17. Details of emission sampling facilities available: Identification of emission Sampling, points ladder Remarks Platforms etc., available 18. Details of Air pollution control system with specifications and drawings. (a) Existing (b) Proposed 19. (a) Capital investment for air pollution control and year of investment Existing Proposed 20. Number and date of consent, if any, under the water (Prevention and control of pollution) Act, 1974 (Central Act of 1984 ...................... 21. Other relevant information, if any Occupier's Signature ................ Name ...................... Address ...................... Explanatory Note - For filling in Form I and the Annexure. The notes given only for those items for which explanation is considered desirable. If the space is not sufficient for filling in my item, the details may be given in separate sheets of paper. Item No. 7. The amount payable as consent fee is specified in Appendix II of the Air (Prevention and Control of Pollution) Rules 1988. The amount may be remitted in cash or as demand draft drawn in favour of the Member Secretary Payable at Shillong. ANNEXURE TO FORM 'Chimney' : Includes any structure with an opening or outlet through which any air pollutant may be emitted. 'Existing' : Means that which is in operation at the time of appliying for the consent. 'New' : Means that which will be broguht into operation in future. 'Altered' : Means that which has been modified due to change in quantity and / or quality of emission, arrangement and / or point of emission etc. Item No. 3 : Here give the name's, designation's and addresses of the persons authorised to receive, on behalf occupier the 'notice' of intention to have sample 'anlysed' served as per section 26 of the Act .............. Item No 4 a. Here state the type of Industry, with reference to the schedule of the Act. Item No 4 b. The Industries are categorised on the basis of the capital investment as follows. Large scale Industry. More than 2 crore rupees; medium scale industry: 20 lakhs to 2 Crore rupees; small scale Industry: Less than 20 lakhs rupees Item No 14 : Analysis of the flue gas emission, process emission and particulates should be done for each stack emission. Whenever stacks are not provided, the shop floor specific pollutant concentration should be reported. Chemical analysis of the particulate matter in the emission is to be done for organic content, metals, non-metals, silicates, radio-active substances, etc. Item No. 16 : Here state the total quantity of ventilation air handled by equipments such as roof extractors, evaporative coolers etc. Item No. 18 : Here give detailed specifications (including efficiency) of the air pollution control system used or proposed to be used. Also furnish the layout of the control systems with dimensions.