FORM NO.--1 [ See Rule 8 ] ( To be Submitted in Triplicate ) Application for consent to operate an industrial plant under section 21 of the Air (Prevention and Control) Act.1981. From ..................... ..................... ..................... To The Member Secretary, Tripura State Pollution Control Board Agartala-Tripura (W) Sir, I/ We hereby apply for consent under section 21 of the Air (Prevention and Control of Pollution)Act. 1981 (Central Act 14 of 1981) to make emission from Industrial Plant owned by (1) .............................................................................(2)........................................... 2. The Annexure, appendices, other particulars and plans are attached here with in Triplicate. 3. I/We further declare that information furnished in the Annexure/Appendices and plans is correct to the best of my/our knowledge. 4. I/We hereby submit that in case of a charge either of the point or the quantity or emission or of its quality a fresh application for CONSENT shall be made and unit such consent is granted, no change shall be made. 5. I/We hereby agree to the Board application for renewal of CONSENT one month in advance of the date of expiry of the consented period for emission, or to be continued thereafter. 6. I/We under take to furnish any other information within one month of its being called for by the Board. Your faithfully, Signature ------------------------------------------ Name of Applicant ------------------------------ Address of Applicant --------------------------- ------------------------------------------------------- Accompaniment : i) Index/site plan : ii) Topographical map : iii) Detailed layout plan of different process and point source emissions and Position of stacks and chimney : iv) Process flow sheet : v) Latest analysis report : vi) Details of air pollution and control devices provided or proposed to be provided : vii) Ambient air quality report, if available : viii) Draft No ... ... ... ... ... ... ... ...........................Date...... ... ... ... ... ... For Rs... ... ... ... ..... .... ... ... .. ... ... ... ................................ ... ...... ... ... ... ... ... ... ........ ... ... ... ... ... ... ... ... ... ...... as consent fee. ANNEXURE TO FORM 1 Existing Chimney. New Altered Note:-- Any applicant knowingly giving incorrect information or suppresing any information pertaining thereto shall be liable to any action under the provisions of the Act.While filling this Annexure the applicant shall for such of the items not pertaining to his activity shall state "Not applicable" against the relevant one and leave blank. 1.a) Full name of the applicant with address ---------------------------------------- ---------------------------------------- ---------------------------------------- (Tel No. -------------------------) b) Is the firm registered ? ---------------------------------------- c) If yes give the number and ---------------------------------------- date of registration and the ---------------------------------------- authority with whom registered ---------------------------------------- d) Full address of the registered ---------------------------------------- office. e) Name. designations and ---------------------------------------- full addresses of persons such as, ---------------------------------------- partners/Managing Director/ ---------------------------------------- Director/Manager etc. ---------------------------------------- f) Under which category dose ---------------------------------------- the institute fall whether ---------------------------------------- Major/Medium/Small scale. ---------------------------------------- 2. Full name of the land /premises/ ---------------------------------------- institute/Factory/Industries/ ---------------------------------------- with Local address Tel No. ------------------------------ Telegraphic Address ------------ ---------------------------------------- ---------------------------------------- 3. Give revenue City /survey No. of District------------------------------- the land/premises for which Town--------------------------------- the application is made Village------------------------------- City Survey No -------------------- Revenue Survey No-------------- Area in Hectares ----------------- 4. State month and year in which ---------------------------------------- the plant was actually put in to ---------------------------------------- commission or is proposed to ---------------------------------------- be put into commission ---------------------------------------- 5. State the Civil/Military Defence District ------------------------------ industrial Estate etc. under whose Corporation ------------------------ administrative Jurisdiction the Municipality------------------------- occupiers industrial plant is Village Panchayet/Cantonment Defence Department -------------------------------------------------------------------------------- ---------------------------------------- State Govt.------------------------- 6.a) State whether plant site has been Prohibited Area-------------------- declared as prohibited area Yes No b) If yes, state the name of the authority ---------------------------------------- and furnish a certified copy -- -------------------------------------- of the order under declared as ---------------------------------------- prohibited area ---------------------------------------- 7. State working season per year ---------------------------------------- of the plant. ---------------------------------------- Form --------------------to---------- From ----------------- -- to--------- From ----------------------to-------- 8. a) Number of persons attending ----------------the factory per day b) Number of persons residing ----------------- in the premises. 9. Indicate the present use of the land in the vicinity (in 5 Km. radius) of the -------------------------------------- i) Human settlements of more than 1.000 population.(Specify population and distance from the plants) ---------------------------------------- ii) Commercial -------------------- iii)Industrial ------------------------ iv)Fisheries ------------------------ v) Sanctuary/National Parks/ Hills Mountains-------------------- ---------------------------------------- vi) Ancient Mountains------------ 10. Climatelogical and Meteorological ---------------------------------------- Details (if available) ---------------------------------------- a) Indicate the climate conditions at the site(e.g.arid semiarid etc) b) Rainfall, yearly average ranges ---------------------------------------- c) Temperature seasonal ranges ---------------------------------------- d) Information on speed and ---------------------------------------- direction of wind ---------------------------------------- e) Humidity, solar Radiation ---------------------------------------- 11.Give list of all materials used in the process in metric tonnes per day. List of raw material Principal use Amount in metric tones per day Note:- A Process flow diagram must be included with this statement showing entry and exit points or all raw materials intermediate products, by products and finished products. Iiable process and control equipment. 12. Fuel consumption in metric tonnes per day Coal Oil Wood Nature Gas Others(Specify) 1. Daily consumption in tonnes 2. Calorific value 3. Ash content percentage 4. Sulphur content percentage 5. Other (Specify) 13. Atmospheric Emission for each: i)Stack No. ii)Material of construction of stack. iii)Stack attached to iv) Stack height. a) Above the roof Mts. v)Stack top : a) Round of circular. b) Inside dimensions of at top. vi)Gas quantity--------------- - m3/Hr. vii)Flue gas temp---------------Co. viii)Exit velocity of the gas--------------m/sec. a) Flue gas Emission Analysis of flue gas in mg/m³ Stack Type of Qty of Type of So2 HC CO Particulate Other No Fuel fuel/hr firing specify b) Process of Emissions : Quality So2 CO2 CO NO2 Analysis of vent gas in mg/m3 Other of gas Hydrocarbons specify m3/hr Particulate c) Particulates analysis(if available) Stack No. size distribution. 50 % _____________________________________________________ 10 % _____________________________________________________ 5 % _____________________________________________________ 3 % _____________________________________________________ 1 % ii) Chemical composition(if available) ------------------------------- 14. Give details of flue gas sampling ------------------------------- arrangements ------------------------------- 15. Give details of laboratory facilities available ------------------------------- for analysis of emission ------------------------------- 16. Is the resufficient space available for ------------------------------- installing air pollution control equipment ------------------------------- 17. Details of air pollution control equipment a)Existing system ------------------------------- ------------------------------- ------------------------------- Give detailed, specifications (b) Proposed (Collectors precipitators, scrubers etc.) 18. State the total quantity of air handled ------------------------------- by ventilation equipments, Specify size ------------------------------- and number of equipments installed or ------------------------------- to be installed. ------------------------------- 19. Give the following details: ------------------------------- a) Total investment in the factory and ------------------------------- the year of investment ------------------------------- b) The estimated expenditure for ------------------------------- implementation the scheme to ------------------------------- Control air pollution. ------------------------------- c) Expenditure incurred to date and ------------------------------- progress achieved(Physical)for air ------------------------------- pollution control, if any and the ------------------------------- year/years of investments along with ------------------------------- physical progress achieved, the firm ------------------------------- to date and the expenditure incurred ------------------------------- and the time required for the completion of the scheme ------------------------------- d)Annual operation and maintenance ------------------------------- cost of air pollution control plant if any ------------------------------- e) Further action that is belong taken by ------------------------------- the firm to control air pollution ------------------------------- 20. Other relevant information, if any ------------------------------- ------------------------------- Signature ------------------------------- Name and address of the ------------------------------- applicant on behalf of ------------------------------- ------------------------------- ------------------------------- Name and address of the firm ------------------------------- ------------------------------- ------------------------------- EXPLANATORY NOTE FOR FILLING IN THE FORM AND THE ANNEXURE The notes are given only for those items for which explanation is considered desirable, FORM 1. Here mention the name of the owner of the land/premises as if other than the applicant industry or factory in continuation of legal business as per the Air (Prevention and control of Pollution) Act. 1981, If land/premises belong to the Factory/Industry say self. The Industries are categorized based on the capital investment, as follows: Major Industry-More than 2 crore rupees capital, Medium Industry-10 lakhs to 2 crore rupees. Small Scale Industry-less than 10 lakh rupees. 2. Here mention the date upto which the consent is sought for ANNEXURE TO FORM Existing means that which is in operation at the time of applying for the consent. New means that which will be brought 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. 1. Here give the Name of the person who is authorized by the Industry/Institution/Factory/Local Bodies to transact their legal business. Item No. 2. Here give the registered name of the Industry/Institution/Factory/Local Bodies etc. under which the business is carried out. Item No. 6. Applicable to only those areas which are prohibited areas such as the ordinance factories, Mint etc. Item No. 10. c) Here State that temperature in 0ºc in summer, winter, monsoon and post monsoon seasons. d) Here State the seasonal average wind direction and speed in and around the site of the plant. The above information can be had from representative meteorological Centre. Item No. 13. Analysis of the flue gas emission process * emission and particulates analysis should be done for each stack emissions Wherever stacks are not provided the shop floor specific pollutants concentrating should be reported. Chemical Analysis of the particulates matter in the emission should be furnished giving details such as organic matter, metals nonmetals radioactive Substances asbestos silicates etc. Item No. 17. Here state the detailed specification of control system used or proposed to be used with efficiency. Also furnish the layout of the control system with dimensions. Item No. 19. Here state the total quantity of ventilation air handed by equipments such as roof extractors. Evaporative coolers etc.
