FORM -1 [See Rule 3(2), 5(2)(3) and (6)(ii)] Application for Obtaining Authorisation for Collection / Reception / Treatment /Transport/ Storage/Disposal of Hazardous Wastes* From: ........... ........... ........... To The Member Secretary, Meghalaya State Pollution Control Board, 'ARDEN', Lumpyngngad, Shillong-793014. Sir, I/We hereby apply for authorisation / renewal of authorization under Sub-rule (2) and (3) and Clause (ii) of Sub-rule (6) of Rule 5 of the Hazardous Waste (Management and Handling) Rules, 1989 for collection/ reception/ treatment/ transport/ storage/ disposal of hazardous wastes. For Office Use Only 1. Code No.: 2 Whether the unit is situated in a critically polluted area as identified by the Ministry of Environment and Forests To be filled in by the applicant Part - A: General 3. (a) Name and address of the unit and location of activity (b) Authorisation required for (Please tick mark appropriate activity/activities): (i) Collection (ii) Reception (iii) Treatment (iv) Transport (v) Storage (vi) Disposal (c) In case of renewal of authorization previous authorization number and date _____________________________________________________________________________ * delete whichever is not applicable 4 (a) Whether the unit is generating Hazardous Wastes (Management and Handling) Rules, 1989 and amendments made thereunder; (b) If so the type and quantity of Wastes: 5. (a) Total capital invested in the project: (b) Year of commencement of production: (c) Whether the industry works general / 2 shifts/ round the clock: 6. (a) List and quantum of products and by-products: (b) List and quantum of raw material 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: 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 treatment effluent plant: (c) If yes, a brief description of unit operations and capacity: (d) Characteristics of final effluent: pH Suspended Solids Dissolved Solids Chemical Oxygen Demand (COD) Biochemical Oxygen Demand *[(BOD5/20°C)/(BOD3/27°C)] Oil and grease (additional parameters as specified by the concerned Pollution Control Board) (e) Mode of disposal and final discharge point: (enclose map showing point) (f) Parameters and frequency of self monitoring: [*] Read BOD (3 days at 27°C) Part - C: Stack (Chimney) and Vent Emissions 10. (a) Number of stacks and vents with height and dia (m): (b) Quality and quantity of stack emissions from each of the above stacks - Particulate matter and Sulphur dioxide (SO2) (Additional parameters as specified by the concerned State 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: Hazardous Waste 11. Hazardous Waste: (a) Type of hazardous wastes generated as defined Under the Hazardous Waste (Management and Handling) Rules, 1989: (b) Quantum of hazardous wastes generated: (c) Mode of storage within the plan, method of disposal and capacity: 12. (a) Hazardous Chemicals as defined under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989: (c) Whether any isolated storage is involved: Yes/No (if yes, attach details) Part - E: Treatment, Storage and Disposal Facility 13. Detailed proposal of the facility (to be attached) to include: (i) Location of site (provide map) (ii) Name of waste processing technology (iii) Details of processing technology (iv) Type and quantity of waste to be processed per day (v) Site clearance (from local authority, if any) (vi) Utilisation programme for waste processes (Product Utilisation) (vii) Method of disposal (details in brief be given) (viii) Quantity of waste to be disposed per day (ix) Nature and composition of waste (x) Methodology and operational details of landfilling/incineration (xi) Measures to be taken for prevention and control of environmental pollution including treatment of leachates (xii) Investment on Project and expected returns (xiii) Measures to be taken for safety of workers working in the plant Place: Signature: Date: Designation:
