Bio-Medical Waste ( Management & Handling) Rules,1998 FORM I (See rule 8) APPLICATION FOR AUTHORISATION/RENEWAL OF AUTHORISATION (To be submitted in duplicate) To, The Prescribed Authority (Name of the State Govt. /UT Administration) Address. Member Secretary Tripura State Pollution Control Board Vigyan Bhawan.Gorkhabasti, Agartala,Tripura West ,PIN- 799006 1.Particulars of Applicant (i) Name of the Applicant (in block letters & in full) (ii) Name of the Institution: Address: Tele No. Fax. No. Telex No. 2. Activity for which authorization is sought: (i) Generation (ii) Collection (iii) Reception (iv) Storage (v) Transportation (vi) Treatment (vii) Disposal (viii) Any other form of handling 3. Please state whether applying for fresh authorization or for renewal: ( in case of renewal previous authorization number and date) 4. (i) Address of the institution handling bio-medical wastes: (ii) Address of the place of the treatment facility: (iii) Address of the place of disposal of the waste: 5. (i) Mode of transportation (in any) of bio-medical waste: (ii) Mode(s) of treatment : 6. Brief description of method of treatment and disposal (attach details): 7 ° (i) Category (see Schedule I) of waste to be handled : (ii) Quantity of waste (category-wise) to be handled per month : 8. Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority. Date: Signature of the applicant Place: Designation of the applicant
