Download No Objection Certificate Application Air Form

Uttaranchal Environment Protection and Pollution Control Board, Dehradun Annexure to Application Form 1-A(Air) nf orm iitcaolpAp eyimn h C Eiitxsng ldtere ewNA Note :ya l manpgtetosal el iba eAWhefguptsaea bhtnnexure,h i herh in iiterannl i l i ito Anifnortc.lkan. htiteb rito wiyggior mano ifnortecnciivnlngknoitcan lpp ny ipressnsup ga fiirovson htdner itco etoananuepso fhte fosuc tespec ihsitcna lpp al nrho tnotta msasdonntohsayse' iittcvi itperatoltnoeave h an' leibcalpap dsal 1.Ful nameoftheapplicantwithaddress ___________________________________ Tel.No. ___________________________________ FaxNo. ___________________________________ (a)Isthefirm registered? (b)Ifyes,givethenumberanddateofregistrationandtheauthoritywithwhom registered. (c)Ful AddressoftheregisteredOf ice (d)Name,designationandful address (1) ofpersonslikepartners/Managing (2) Director/Manageretc. (3) (4) (e)Underwhichcategorydoesthe industryfal ,major/medium/smal scale _____________________________ 2.Ful nameoftheland/premises/Institute/ ______________________________ Factory/Industry/LocalBodywithaddress ______________________________ TelNo. ______________________________ TelegraphicAddress. ______________________________ 3.Giverevenue/CitySurvey District _______________________________ (a)No.oftheland Town _______________________________ prmieowhchVl g_______________________________ essfrihte iae aplcatonismae iySreo_______________________________ piidCtuvyN. Rev.SurveyNo. _______________________________ Areainhectares ________________________________ 4.Statemonthandyearinwhichtheplant ________________________________ wasactual yputintocommissionoris ________________________________ proposedtobeputintocommission ________________________________ Mi/I diltnusra feenceD / itary l Dieewheami iittnsrave dos / l iivdtcuner. h ittsrc 5Stta.EttsaeCetCitorporaon nt hiitcoJidurs eP iilncpal agMui V eosiss me idttuae dillittnusrapan ' iccuper Ctanon / htancayaity feenceD /tn pt .e D eG dA rea tov. trus itetTibPorSttaPhro tov. AhittuoryGCltenraPtorir A o.N )Sewh tta Yes lecare eeaits ehsbnddasp ltpan hteerrea iteb ihro da drerfhtop iurnso nhittuorlecareee fht a areFro hheaso ic )Ifyetenmeoeayadfhacdcyoeo inttessa,whhtahsbnddaeaspkr duner7Stta. ewogsnp m________________T ie fiter rea iteb ihro da ltan fhtoyearer ep Year F ul ear Everoo ses tacorre h inden FroFrose Bhtacfooperson.fooperson. / Citonnuous m________________T m________________T -wiyY)Nsat gtefyp)Nsrepmi dayer a6(. b6(. a8(. hindies gint b8(. _____________________me tres tres tres ______________________me______________________me ite. Din&D egree fht y(5Km.)oes iusitrecodra iiitcnitsance n litopuao manset memoetn100pn(ypnadd fispec litopuao 0 ha r fo tn le m tep hfro )ltan (i )Cmme ilrca o (i )I diltnusra )F ihiseresiv (l ;s / PkarsMo )SHi iltaonaN / tancuaryitunans v ( )AMome tnsnuitnceniv () lelbafiavai )onnes )Dinoeoesetepeoelnt diev)H hanite fhtfht usflsoptresenh itreco itcau fi 8(.9Idn.( ite l htditeat iitonlilteroogca don ti l10dmes(mah liltoogcaan itca )Ietecmaecsaes dn i l C.a ()tc. iar/dse,iegar..( mide anges verag lyear, ifan )Ral yaer b ( )Hmt h fro Lleve / ihteg e8(. lteraureseasonaranges, )Tmpfnordn iitreconfspeeito ecd (( )Imanodaddnofwi )Hmiforaitr roceshseiltera d uits 11.Lw masudinteps(Mect iitaondra iltysoar, e ( )DieofHiwayfm tes)Dieodfmtes ite hitedoa heRrorohgRoaf tsanctsanc cd8(.8(. AmotuninmeitrcTonnes/Day PiilrncpaUse LitsfoRaw Mailteras f dn itpon itx/ ndLbltroucsaeproces, tnra lun Apsfwdmmueidwihtssmewigeyadeso hsoiihnse al wmameepypsadfdpsa tnmeAlinaysn12nictmpnme ittaedtrouc h t s. ldncuedbtroucs, s. leve bitr tsita d foorouninson hhieissons iagratn. ito ilitterasner, )SkNo.bovbovop oundinsalotactaclualitconroequpFlueconsu. iroces((lu )Aetermt ra ()Adletmtega ( )Skt)Rdo)Iedmesa vi )Fegstmp-OC )FeGsEmisoffegsinmgm3 1) Others, ispecfy 56 Nltaura Gas Wodo 34 Diesel Oil 2 1 Cloa 13Ato.mshipercEmiissonforeachstack 1.DialyConsumpitonin tonnes 2Cliaor.ficvlaue 3As.hCtonent% 4Slhupur.Cttonen% 5.Othiersspec,fy fktsac ilfittteraoconsruco (i no )Ma ohace tac (i )Skat dt ihteg taciv )Skh ( hr ittuan aiv ( )GsQy-m3/ Others, ispecfy Pilttarcuae CO HC SO2 Typeof Fiirng Qittuany fo flue/m3 Typeof Flue Sktac No. day/ones a (b (ilrcuarC r a ( v (topt b ( )PsEmi isson roces ))))) 23456 ((((( Alinayssoftvengasinmg/m3 Others, ispecfy Pilttarcuae Hydbrocarons NOx CO CO2 SO2 Qluaity fogas (c)Pilttarcuaealinayss(StackNifiavalbale) o. _____________________ diitsrbituon 50µ _____________________% 10µ5µ _____________________% _____________________% 3µ _____________________% 1 µ _____________________% (i )Chemilcacompiitoson(ifiavalbale) ______________________ 14.Giveditealsoegassamplingar angemetnsfflu ______________________ 15.Giveditealsoflbtaoraoryfiacliitesaivalbalefor lianayssofemiissons. ______________________ 16I.stheresuf iitcenspaceaivalbalefor itnsal ingair-pol ituonclitonroequpmetn _______________________ 17D.itealsofiar-pol ituonclttonrosysem.Give )Eiiitxsng(a____________ ropose )Pd ____________ leditea ds tecors,)tc. ber iibttprecpaorsscru, ol se C iitcaonfipec s( b ( dn iz fe Sitnpec.l itnsiteatn litttoaquan niqupfioequp ode. hlitaoerh tns itvenv nub. etetyo 18Stta. nemeyseambmeal doeial 19Gietefol wigds: dby lehdanfiartn tnves oearhntacorhn itnves ltoa )Tmetintefyadteyfime nta e nc itur dxpen bc (( )Eeiur dtodeadp ltonro hcehitnn leior itur dxpen te itsituon. hiar )Teemadeefmpmegtesmetoc-pol b (tora (rogress achieved(physical)forair-pol utioncontrol, ifany,andtheyear/yearsofinvestments alongwithphysicalprogessachieved,the Fimsoliedtisoatoaeo rhudgvealfcintknt dateandtheexpenditureincur edandthe timerequiredforthecompletionof thescheme____________________________ (d)Annualoperationandmaintenancecost ______________________________ ofair-pol utioncontrolplant,ifany. ______________________________ (e)Furtheractionthatisbeingtakenbythe ______________________________ firm tocontrolair-pol ution. ______________________________ 20.Otherrelevantinformation,ifany ______________________________ Signature________________________________ NameandAddressoftheapplicantonbehalfof: NameandaddressoftheFirm _______________ onbhlowhcplctosmae eaffihapiainid________