Download Application for Competent State Authority-cum-site Appraisal Committee

APPLICATION FOR COMPETENT STATE AUTHORITY-CUM-SITE APPRAISAL COMMITTEE (Grant of Environmental Clearance from CSA and Approval of Site from SAC) For Office Use Only Code Number __________________________________ Date of Receipt __________________________________ CSA Approval No. & Date __________________________________ SAC Approval No. & Date __________________________________ To be filled by Applicant: 1. GENERAL 1. Name & address of the Industry 2. Present Address for correspondence Phone Number Fax Number 3. Whether - Large/Medium - Small Scale Yes/ No Yes/ No 4. Number and date of SSI registration/ IEM/ LOI 5. Name and address of applicant for industrial license/ SSI 6. Name of Directors/ Partners 7. Likely date of commissioning 2. LOCATION 1. Give the location of the Industry with complete address 2. Area of land proposed to be acquired/ already acquired 3. Is the land situated within any Municipal Jurisdiction? 4. Is the Land situated outside the Lal Lakir of nearest village? 5. Is the land situated in an approved industrial Zone/ Industrial Estate/ Focal Points/ FEZ area? 3. PRODUCTS AND RAW MATERIAL DETAILS 1. List of main products proposed to be produced with designed daily production capacity 2. List of by-products proposed to be produced with daily production capacity 3. List all raw materials with daily consumption at full production capacity 4. List all processing chemicals materials consumed daily with expected quantities 4. MANUFACTURING PROCESS (For Details attach Annexures as at V) 1. Process flow diagram 2. Brief write up on process and technology 3. Critical process parameters such as pressure build up, temperature rise and run-away reactions. 4. Other external effects critical to the process having safety implications, such as ingress of moisture or water, contact with incompatible substance sudden power failure 5. Highlights of the built-in safety/ pollution control devices or measures incorporated in the manufacturing technology. 5. POWER LOAD REQUIREMENTS 6. DOMESTIC SERVICE 1. Number of persons to be served 2. Water Supply, sources & daily consumption M3/day 3. Sewerage collection system Sewer/ Open drain 4. Sewerage treatment Separate/ With Industrial effluent 7. WATER REQUIREMENT 1. Source of Water Supply 2. Average daily consumption of water for: a. Process b. Washings c. Cooling d. Sanitary purpose e. Others Total Quantity (in MP3/day) 8. WASTE WATER DISCHARGE Quantity (in M3/day) 1. Waste Water Discharge a. Process b. Washings c. Cooling d. Sanitary (Sewage from toilets/ sludge from hand washing etc.) e. Other Total 2. Does industry proposed to re-circulate any or all the above waste streams 3. If yes, a. Quantity to be re-circulated cooling purposes b. Quantity to be re-circulated trade effluent 4. a. Whether effluent need any treatment: b. If yes, whether conventional or special (give detailed description) 5. Point of final discharge (in case of water body give name, if for irrigation on land, give area in Hectare)) Agricultural land/ public sewer/ Inland surface water/ River/ Choe/ Stream/ Drain/ Nallah. 9. WATER REQUIREMENT 1. Indicate characteristic of Waste Water to be discharged a. Temperature b. pH c. Colour d. Total suspended solids, mg/l e. Total dissolved solids, mg/l f. BOD, mg/l g. COD, mg/l h. Heavy Metals (Ni, Cr, Zn, Hg etc.) mg/l i. Cyanide mg/l j. Others 2. Other special toxic substance proposed to be discharged? Please specify nature and concentration (inorganic, organic including pesticides and organo chloro-compounds phenol, Lignin, mercaptan, heavy metals and radioactive substance) Quantity (in M3/day) 10. SOLID WASTE 1. Total quantity or solid wastes in tonnes per day along with its characteristics. 2. Method proposed for disposal including treatment plant sludge (Land fill/ Dumping/ Composting/ Incinerator) 11. SOURCES OF AIR POLLUTION Source of Energy Make/Type of Equipment Type & quantity of fuel to be used Capacity i) Boiler ii) Furnace iii) DG Set iv) Others 12. Whether fluidized bed furnace or not 13. ATMOSPHERIC EMISSIONS (IF APPLICABLE) 1. Emissions from fuel burning (if available) a. fuel gas quantity m3/day b. Particulate matter mg/N m3 c. Stack details i. Material of construction ii. Internal diameter 1. Top 2. Bottom iii. Ht. From ground level (m) from roof of building 2. Emission from process (if available) in Nm3/hr. a) Expected emissions quantity b) Composition of emissions i) Particulates (Nature and quantity) ii) Gases iii) Sulphur Dioxide iv) Nitrogen Dioxide v) Carbon Monoxide vi) Ammonia vii) Acid Mist viii) Flourine ix) Chlorine x) Halogens xi) Hydrocarbons xii) Mercaptans xiii) Other specify c) Stack Details i) Material of construction ii) Height from GL Height from the top of the building (give details of stacks for each process emission) Within Work environment (m) (m) Outside Work environment 3. Average, minimum and maximum of Temperature Humidity Wind velocities during the previous 10 years. 4. Seasonal variation of the wind directions along with wind rose 5. Highest water level reached during the floods in the area recorded so far 6. Lightening and scismic data of the area 14. Whether Air Pollution Control System required to be installed? If yes, give details 15. HAZARDOUS WASTES AND CHEMICALS (Enclose Safety data sheet of each hazardous chemical) 1. Hazardous Wastes [as defined in Hazardous Wastes (Management & Handling) Rules, 1989] a. (i) Category of Hazardous Wastes (ii) Quantum of hazardous Wastes generated in each category b. Method of disposal/treatment c. Mode of storage in the plant with storage capacity. 2. Hazardous chemicals (as defined in the manufacture, storage and import of hazardous rules, 1989) a. Name of chemicals used and their quantity b. Whether any isolated storage outside factory premises is involved, if yes, give details c. Whether emergency plans have been proposed for taking: i. On site measures ii. Off site measures iii. Proposed arrangements, if any, for mutual aid scheme with the group of neighbouring factories. 3. Main and intermediate storage proposed for raw materials/ intermediates/ products/ by products (maximum quantities to be stored at any time) 4. Transportation method to be used for materials inflow and outflow, their quantities to be stored at any time. 5. Safety measure proposed for: Handling of materials Internal & external transportation Disposal (packing and forwarding of finished products) 16. ESTIMATED COST OF POLLUTION CONTROL 1. Total project cost 2. Expenditure proposed for a. Water Pollution Control b. Air Pollution Control c. Disposal Arrangements d. Solid Waste handling./treatment e. Expenditure proposed for Pollution monitoring 3. Total Capital Investment proposed on Pollution Control as a &age of total investment of the industry. Existing equipments & systems will be utilized. 17. Any other additional information likely to have beneficial or adverse environmental affect. Place: Date: Signature: _________________________ Name: ____________________________ Designation : _______________________ Address: ___________________________ __________________________________ __________________________________ Enclosures:- i) Site Plan with clear identifications of boundaries and total area proposed to be occupied and showing details nearby the proposed site. a. Historical monument, if any in vicinity. b. Name of the neighbouring manufacturing units and human habitants, educational and training institutions, storage of LPG and other hazardous substances in the vicinity and their distances from the proposed unit. c. Water resources (rivers, streams, canals, dams, water filtration plants etc.) in the vicinity. d. Nearest hospitals, fire stations, civil defence stations and police stations and their distances. e. High tension electrical transmission lines, pipe lines for water, oil, gas or sewerage, railway lines, roads, stations, jatties and other similar installations. ii) Location Plan (indicating Plot Number, Khasra Number) and main highways and other references. iii) List of Directors/Partners. iv) Copy of Letter of Intent/ Licence DGTD Registration Certificate/ SSI Certificate/ Any other. v) Manufacturing process details alongwith flow sheet and material/ energy balance statement vi) Project report indicating:- a. A summary of the salient features of the project b. Status of the organisation (Government, Semi-Government, Public or Private etc.) c. Maximum number of persons likely to be working in the factory. d. Maximum amount of power and water requirement and source of their supply e. Block diagrams of the buildings and installations in the proposed site. f. Details of the housing colony, hospital, school and other infrastructural facilities proposed. g. Person responsible for protection of Safety, health and environment. h. Proposed health and safety policy of the proposed enterprise. vii) CSA Fee Rs.......... DD in favour of Member Secretary, Punjab Pollution Control Board, Patiala No............. dated .......... viii) Copy of feasibility report on the pollution control of Water/Air Pollution/ Solid waste. ix) Copy of certificate from concerned authority the proposed site is located in FEZ/Industrial Area/ Focal Point decimated by Town and Country Planning Department/ Outside Lal Lakir. x) One copy of Partnership Deed/ Article of Association of Memorandum xi) Process Hazards Information: a. Enclose a copy of the report on environmental impact assessment b. Enclose a copy of risk assessment study c. Published (open or classified) reports, if any, on accident situations/ occupational health hazards of similar plants (within or outside the country) d. Details of fire fighting facilities and minimum quantity of water, carbon dioxide and other fire fighting measures needed to meet the emergencies. e. Details of in-house medical facilities proposed.