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Consent and Renewal Fee payable at Different Period:

From Sept. 1987 to Dec. 1990

From Jan to Sep. 1994 S. No

Investment of the Unit

Consent Fees

(Thousand)

Renewal Fees

(Thousand)

Consent Fees.

(Thousand)

Renewal Fees.

(Thousand)

a. More than Rs. 3 Crores

20,000/- 5000/- 25000/- 10000/-

b. More than Rs. 1 Crores but less than Rs. 5 Crores

10000/- 2500/- 15000/- 5000/-

c. More than Rs. 35 Lakhs but less than Rs. 1 Crores.

5000/- 1000/- 7000/- 2000/-

d. Less than Rs. 35 Lakhs but less than Rs. 1 Crores.

1000/- 250/- 1000/- 500/-

Consent Fees includes first year Licensee Fees (Amendment dated: 29/10/1994)

From Oct. 1994 to Dec.

1997 From Jan. 1998 to till date S.

No. Particulars.

Consent Fees

(Thousand)

Renewal Fees

(Thousand

Consent Fees

(Thousand)

Renewal Fees

(Thousand)

a. More than 200 Crores

100,000/- 30,000/- 1,50,000/- 50,000/-

b. More than 100 Crores but less than 200 Crores.

75,000/- 25,000/- 100,000/- 40,000/-

c. More than 50 Crores But less than 100 Crores.

60,000/- 20,000/- 75,000/- 30,000/-

d. More than 10 Crores but less than 50 Crores.

50,000/- 15,000/- 60,000/- 20,000/-

e More than 03 Crores but less than 10 crores.

30,000/- 10,000/- 40,000/- 15,000/-

f More than More than 50 Lakhs but less than 3 Crores.

7,500/- 2,500/- 10,000/- 3,500/-

g More than 10 Lakhs but less than 50 Lakhs

2,000/- 750/- 1,000/- 500/-

h More than 3 Lakhs but less than 10 Lakhs.

1,000/- 300/- --- ---

Investment Means - Total Gross investment of the unit without depreciation, it including Cost of land, Building, plant and machinery etc. excluding working capital.

vvkkoossnu inu i= = ddk k iizzkk##i i &&

11-- ookk;;q q llEEeeffr r vvkkoossnu nu ii= = &&

FORM - 1 FOR AIR CONSENT

(See Rule 13) (To be submitted in Duplicate)

APPLICATION FOR CONSENT FOR EMISSION/CONTINUATION OF

EMISSION UNDER SECTION 21 OF THE AIR (PREVENTION AND CONTROL

OF POLLUTION ACT, 1981)

Date : From : ................................. ................................. ................................. To, ………………………………….. ………………………………….. ………………………………….. I/We hereby apply for Consent/Renewal of consent under Section 21 of the Air (prevention and Control of Pollution) Act 1981 (No. 14 of 1981) to bring into use a new/altered "Stack for the discharge of Emission/to begin to make new discharge of emission/to continue to discharge emission" from stack in Industry owned by .....................................................................................The relevant details are as below :- 1. Full name of application, designation with address & Telephone No. :

.......................................................................................................................... .......................................................................................................................... ..........................................................................................................................

2. Name of full time Directors with address & Telephone No. :

......................................................................................................................... .........................................................................................................................

3. Full factory address (with name of Plot/Premises) & Telephone No. :

........................................................................................................................ ........................................................................................................................ ........................................................................................................................

4. Date of commissioning of factory or proposed date of commissioning of

Factory: 5. Capital investment made (Rs. In Lakhs) 6. Total No. of Employees : 7. (A) Licensed Annual Capacity of the factory :

(B) Attach a brief of the manufacturing process along with a flow, diagram and the position of corresponding Stack on the Plot plan.

8. State the number of boilers, heaters, furnaces installed in the factory along

with their capacity type/quantity of fuel used and emission from the stacks ............................................................................................................................

............................................................................................................................ ............................................................................................................................

9. Stack's details :

(a) Number of Stacks : (b) Natural draft/I.D.Fan/F.D. Fan : (c) Material of construction of stack : (d) Hight of Stacks :

(i) Above ground level (Meters) : (ii) Above factory room (Meters) :

10. Attach information on Air Pollution Control Equipment in respect of each of

the Stacks listed in item 9 above. (a) Name of equipment : (b) Existing or Proposed and for which : pollution and date of installation (c) Reduction efficiency guarantteed by : the manufacturer (d) Quantity & Quality of current/expected : emission (e) Whether the industry works in general : shift or 2 shift or round the clock (e) Whether monitoring is being done or :

proposed 11. Attach information on compliance of emission with respect to the Standard.

12. I/We declare that the information furnished above is correct to the best of my/our knowledge.

13. I/We hereby submit that in case of change either of the point of the emission

or its quality, a fresh application for consent shall be made until such consent is granted no emissions shall be made.

14. I/We hereby agree to submit the State Board an application for renewal of

consent one month in advance of the date of expiry of the consented period for stack emission if to be continued thereafter.

15. I/We undertake to furnish any information within one months its being called

by the State Board.

I/We enclosed herewith cash Receipt No. .................................. Bank Draft

No ..............................................dated ..................... for Rs. .............. (Rupees ............................................................................................) in favour of Madhya Pradesh Pollution Control Board, as has been payable

under Section 21 of the Act. Yours Faithfully, Signature of the Applicant Signature of the Applicant Accompaniments : 1. Site plan, lay out & to be sheet. 2. A copy of Project Report. 3. Name of Local Body/panchayat. 4. List of industries, villages rivers & lakes and other Salient feature and

distances from site, within a radius of 5/10 Km. In case of medium/large industry.

Note : 1. Any applicant knowingly giving incorrect information of suppressing any

information pertaining there to shall liable to be punished under the Act. 2. "Strikeout which is not relevant".

22-- tty y llEEeeffr r vvkkoossnu nu ii= = &&

FORM - 1 FOR WATER CONSENT

(To be submitted in triplicate) Application for Consent for establishing or taking any steps for establishment of Industry/ Operation/ Process/ or any treatment/ disposal system for discharge, continuation of discharge under section 25 or section 26 of the Water (Prevention & Control of Pollution), Act 1974.

(See Rule 3)

Date: From: ------------------------------------- ------------------------------------- ------------------------------------- To, ……………………………….. ………………………………. Sir, I / We here by apply for Consent/ Renewal of consent under section 25 or section 26 of the Water (Prevention and Control of Pollution) Act. 1974 (No. 6 of 1974) for establishing or taking any step for establishment of Industry/ operation/ Process/ or any treatment/ disposal system to bring in to use any new/ altered outlet for discharge of sewage/trade effluent/ to continue to discharge Sewage/ trade effluent from land/ Premises owned by………………………………………………………………………………. The other relevant details are as below:- 1. Full name of applicant ………………………………...………… 2. Nationality of the applicant …………………………………………… 3. Status of the applicant ……………………………………………

a) Individual ……………………………………………

b) Proprietory concern ……………………………………………

c) Partnership firm ……………………………………………

(Whether registered or unregistered)

d) Joint family concern ……………………………………………

e) Private Limited Company …………………………………………… e) Public Limited Company …………………………………………… g) Government Company

(1) State Government …………………………………………… (2) Central Government …………………………………………… (3) Union Territory ……………………………………………

h) Foreign Company ……………………………………………

(If a Foreign Company, the details of registration, incorporation etc.) i) Any other Association or Body …………………………………………… 4. Name, Address and Telephone No. of the ……………………………………………

applicant [the full list of individuals, partners persons, Chairman (Full time or part time) Managing Directors, Managing Partners/ Directors (Full time or part time) other kinds

.…………….…………………………… of office bears are to be furnished. With their period of tenures in the respective office, with telephone No. and address]

5. Address of the Industry …………………………………………… (Survey No, Khasra No, Location as per............................................................ ……………………………………………

the Revenue Record, Village, Firka. Tehsil, District, Police Station or SHO, Jurisdiction of the First-Class Magistrate) ……………………………………..

6. Details of Commissioning etc: a) Approximate date of the Proposed................................................................. ……………………….………………….. commissioning of work. b) Expected date of Production/date of production (if Existing)………………..…………..……………… .....................

7. Total Number of employees expected to be ……………….………..………………….............................................................. employed 8. a)Details of license, if any obtained under

……………….…………….…………….the provisions of Industrial Development Regulation Act.1951.

b)Total capital investment and category …………………………………………… (SSI/Medium/Large). (Gross capital

investment) 9. Name of the person authorized to sign this

.…………………………….……………form (the original authorized except in the case of individual /proprietary concern to be…………………………..………………enclosed.)

10. a) Attach the list of all raw materials and

Chemicals used per month. b) Licensed annual capacity of the Factory /

Industry and name of Product. c) Manufacturing Process in details. …………………………….…………… 11. State daily quantity of water in kilolitres and ……………………………….………… its source (Domestic/Industrial/Process/Boiler /

Cooling/Other) Domestic ………………………….……………… Industrial ………………………….……………… Process ……………………….………………… Boiler ………………………….……………… Cooling ……………………….………………… Others ………………………………………… 12. a) State the daily maximum quantity of …………………………….…………… effluents & mode of effluents and mode

of disposal (sewer or drains or river)

also attach analysis repot of the effluents.

Type of effluent quantity in kilolitres mode of disposal. i) Domestic....……………………………………… ii) Industrial ……………………………………… iii) Others…………………………………........... b) Quantity of effluent currently being discharged or expected to be discharged. c) What monitoring arrangement is currently there are proposed. …………………………………………

13. 1)State weather you have any treatment………………………………………plat for industrials, domestic of combined effluents. (Yes/No./Proposal)

2) If yes, Proposal attach a description of..........……………………………………… the process of treatment in details along with drawing & design and give the investment on (E.T.P.).

3) Attach information on the quality of treated…………………………...…………… effluent vis-à-vis the standards. 14. State details of solid wastes. Generated…………………………………………

From process and during waste treatment.

Description Quantity/Quality Method of collection Method of disposal 15. I / We further declare that the information furnished above is correct to be

best of my /our knowledge. 16. I / We hereby submit that in case of change either of the point of the

discharge or quantity of discharge or its quality, a fresh application for consent shall be made and until such consent is granted no change shall be made.

17. I / We hereby agree to submit to the State Board an application for renewal

of consent four Months in advance of the date of expiry of the consented period for out let/ discharge to be continued thereafter.

18. I / We undertake to furnish any other information within one month or its being

called by the State Board. 19. I / We enclose herewith cash receipt No./bank Draft

No……….................................…….Dated……….........................…...for( Rs.in Figures)……………………………(Rs. in words ....................….............………………………………...)in favour of Member Secretary, Madhya Pradesh Pollution Control Board, as fees payable under section 25 of this Act

Accompaniments : 1. Site plan & topo sheet. 2. Lay out and statement of (total area of the plant/ constructed area/ open area/

area reserved for plantation. 3. a) Name of Local Body / Panchayat. b) NOC from GOI/State Govt./Local Body/ Panchayat / etc. 4. List of Industries, villages, rivers & lakes other important feature and

distances from site, within a radius of 5/10 km. in case of medium / large industry.

5. A copy of Project Report. 6. Flow sheet of process and chemical involved (if any) Your Faithfully, Signature of the Applicant.

GOVERNMENT OF MADHYA PRADESH HOUSING & ENVIRONMENT DEPARTMENT

NOTIFICATION

Bhopal, Dated: 27 Dec. 1997 No F (121) 32/90 – In exercise of the powers conferred by Section 64 of the

Water (Prevention & Control of Pollution) Act, 1974 (No. 6 of 1974). the State government, after consultation with the Madhya Pradesh Pollution Control Board, hereby makes the following further amendments in the Water (Prevention & Control of Pollution) (Consent) Madhya Pradesh Rules, 1975 namely :-

AMENDMENTS In the said Rules :-

1) In clause (i) of rule 2 for works "License Fee" the words "Consent Renewal Fee" shall be substituted. 2) for sub rule (V) of rule 4, the following sub rule shall be substituted, namely :-

"(V) The application form should be duly accompanied with the consent fee as a specified in the following schedule:-

SCHEDULE Industries having an investment of :- 1) More than 200 crores 1,50,000.00

2) More than 100 crores but less than 200 crores. 1,50,000.00 3) More than 50 crores but less than 100 crores. 75,000.00 4) More than 10 crores but less than 50 crores 60,000.00 5) More than 3 crores but less than 10 crores 40,000.00 6) More than 50 Lakhs but less than 3 crores 10,000.00 7) More than 50 Lakhs 1,000.00

The above consent fee includes the consent renewal fee for the first year.

2. For sub-rule (5) of rule 5 the following sub rule shall be substituted namely :-

"(5) The applicant shall pay an annual" Consent renewal fees" (except the fee for the first year) to the Board as specified in the following schedule namely:-

(A) Industries having an investment of :- Rs.

1. More than 200 crores. 50,000.00 2. More than 100 crores but less than 200 crores. 40,000.00 3. More than 50 crores but less than 100 crores. 30,000.00 4. More than 10 crores but less than 50 crores 20,000.00 5. More than 3 crores but less than 10 crores 15,000.00 6. More than 50 Lakhs but less than 3 crores 3,500.00 7. More than 50 Lakhs 500.00

(B) Annual consent renewal fee and consent fee chargeable from local bodies

extracting water from natural resources and discharging effluent into streams shall be as under :-

Rs. a) Municipal corporation 3000.00 b) Class A-A municipalities 2000.00 c) Class A municipalities 1000.00 d) Class B municipalities 500.00 e) Class C municipalities 250.00 f) Minimum fee 250.00 Provided that the consent application and consent renewal application received to the publication of this notification shall not be liable for the excess payment of difference of fees owing to pendncey of application. By order and in the name of the Governor of Madhya Pradesh S/d. (G.V. Upadhyaya) Deputy Secretary Government od Madhya Pradesh Housing and Environment Department

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mm||kkssxxkkssa a ddh h JJss..khkh iizzkkff//kkddkkj j ggssrrq q iizz''kkkkllffuud d OO;;; ;

¼¼::IkIk;;ss½½ iizzkkff//kkddkkj j uuoohhuuhhddjj..k k ggssrrq q iizz''kkkkllffuud d OO;;; ; ¼¼::IkIk;;ss½½

o`gn ,oa e/;e Js.kh 10]000-00 6]000-00 ¼izR;sd nks o"kZ i'pkr~½

y?kq Js.kh 5]000-00 3]000-00 ¼izR;sd nks o"kZ i'pkr~½

• vvkkoossnu inu i= = ddk k iizzkk##i i && QQkkeeZ Z &1&1

Form -1

[See rules 3(2), 5(2)(3) and (6) (ii) ]

Application for Obtaining Authorisation for Collection/ Reception/ Treatment/ Transports/ Storage/ Disposal of Hazardous Waste*

From: ....................................

..............................................

..............................................

To

………………………………….

Madhya Pradesh Pollution Control Board,

...................................................................

...................................................................

Sir,

I / We hereby apply for authorisation./ renewal of authorisation under sub-rule (2) and (3) and clause (ii) of sub-rule (6) of rule 5 of the Hazardous Wastes ( Management and Handling ) Rules, 1989 for collection/ reception/ treatment/ transport/ storage/ disposal of hazardous wastes.

For Office Use Only

• Code No. :

• Whether the unit is situated in a critically polluted area as identified by Ministry of Environment and Forests;

To be filled in by Applicant

Part - A: General

3. (a) Name and address of the unit and location of activity

• Authorisation required for ( Please tick mark appropriate activity / activities : • Collection

(ii) reception

(iii) treatment

• transport • storage

• disposal

(c) In case of renewal of authorisation previous authorisation number and date

*delete whichever is not applicable

4. (a) Whether the unit is generating hazardous waste as defined in the 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 on 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 m 3 /d

(b) Process m 3 /d

(c) Domestic use m 3 /d

(d) Others m 3 /d

9. Sewage and trade effluent discharge ;

(a) Quantum of discharge m 3 /d :

(b) Is there any effluent treatment plant :

(c) If yes, a brief description of unit operations with capacity :

(d) Characteristics of final effluent:

pH

Suspended solids

Dissolved solids

Chemical Oxygen Demand (COD)

Biochemical Oxygen Demand a [ ( BoD 5 / 20 o C )/BoD 3 /27ºC ]

Oil and grease

( additional parameters as specified by the concerned Pollution Control Board )

(e) Mode of disposal and final discharge point :

( enclose map showing discharge point) :

(f) Parameters and Frequency of self monitoring :

[*] Read BOD ( 3 days at 27 o 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 emission from each of the above stacks-particulate matter and Sulphar dioxide ( SO 2 ) ( Additional parameters as specified by the concerned 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 Wastes :

(a) Type of hazardous wastes generated as defined under the Hazardous Wastes (Management and Handling) Rules, 1989:

(b) Quantum of hazardous waste generated:

(c) Mode of storage within the plant, method of disposal and capacity:

12. (a) Hazardous Chemicals as defined under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989)

(b) Whether any isolated storage is involved (if yes, attach details) Yes / No

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) Utilization programme for waste processed ( Product Utilization )

(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

• Investment on Project and expected returns • Measures to be taken for safety of workers working in the plant •

Place : Signature : …………….

Date :

Designation : …………

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i= • mÌs'; & iznw"k.k fu;a=.k • ik=rk & tho fpfdRlk vif'k"V izca/ku fu;e ds vUrxZr • ik=rk dk vk/kkj & mijksDr fu;eksa ds izko/kku • izkIr djus dh izfdz;k & 1- 500 fcLrj ls vf/kd ds laLFkku fu/kkZfjr vkosnu i= 'kqYd lfgr cksMZ eq[;ky; esa izLrqr djrs gSA 2- 500 fcLrj ls de ds laLFkku {ks=kuqlkj lacaf/kr {ks=h; dk;kZy;ksa esa fu/kkZfjr vkosnu i= 'kqYd lfgr izLrqr djrs gSA • vkosnu 'kqYd &

1- 200 djksM+ ls vf/kd 1]50]000-00 2- 100 djksM+ ls vf/kd fdUrq 200 djksM+ ls

de 1]00]000-00

3- 50 djksM+ ls vf/kd fdUrq 100 djksM+ ls de

75]000-00

4- 10 djksM+ ls vf/kd fdUrq 50 djksM+ ls de 60]000-00 5- 3 djksM+ ls vf/kd fdUrq 10 djksM+ ls de 40]000-00 6- 50 yk[k ls vf/kd fdUrq 3 djksM+ ls de 10]000-00 7- 50 yk[k ls :i;s ls de 1]000-00

• vvkkoossnu inu i= = ddk k iizzkk##i i &&

FORM I

(see rule 8)

APPLICATION FOR AUTHORISATION (Bio-Medical Waste (Management and Handling) Rules, 1998)

(To be submitted in duplicate.)

To

The Prescribed Authority (Name of the State Govt/UT Administration) Address.

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 authorisation 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 authorisation or for renewal: (In case of renewal previous authorisation-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 1) 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

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� Form –I

[see rules 4(2) & 6(2)]

Application for obtaining authorization

To,

The Member Secretary

---------------------------

---------------------------

1. Name of the municipal authority/Name of the

agency appointed by the municipal authority

:

2. Correspondence address

Telephone No.

Fax No.

:

3. Nodal Officer & designation(Officer authorised

by the municipal authority or agency responsible

for operation of processing or disposal facility)

:

4. Authorization applied for (Please tick mark) : (a) Setting up & operation of

waste reprocessing facility

(b)Setting up & operation of

disposal facility

5. Detailed proposal of waste processing/disposal

facility (to be attached ) to include

:

5.1 Processing of Waste

i. Location of site

ii. Name of waste processing technology

iii. Details of processing technology

iv. Quantity of waste to be processed per day

v. Site clearance (from local authority)

vi. Details of agreement between municipal

authority and operating agency

vii. Utilization programme for waste processed

(Product utilization)

viii. Methodology for disposal of waste

processing rejects (quantity and quality)

ix. Measures to be taken for prevention and

control of environmental pollution

x. Investment on Project and expected returns

:

xi. Measures to be taken for safety of workers

working in the plant

5.2 Disposal of Waste

i. Number of sites identified

ii. Layout maps of site

iii. Quantity of waste to be disposed per day

iv. Nature and composition of waste

v. Details of methodology or criteria

followed for site selection

vi. Details of existing site under operation

vii. Methodology and operational details of

land filling

viii. Measures taken to check environmental

pollution

:

Date Signature of Nodal Officer

Form - II

[See rule 4(4)]

Format of Annual Report to be submitted by the Municipal Authority

i. Name of City/Town:…………………

ii. Population ………………………

iii. Name of municipal body:………………….……………………………… and

Address ………………………………………………………………

………………………………………………………………………………

Telephone No. : ………………………….

Fax : …………………………

iv. Name of Incharge dealing with municipal solid wastes …………

…………..…………………………………………………………… with

designation …………………………………………………………………..

1. Quantity and composition of solid wastes

(i) Total quantity of wastes generated per day

---------------------------------------------------------

(ii) Total quantity of wastes collected per day

-------------------------------------------------------------------

(iii)Total quantity of wastes processed for :

a. Composting:

………………………………………………………………

b. Vermiculture:

………………………………………………………………

c. Pellets: ………………………………………………………………

d. Others, if any, please specify

…………………………………………………….

(iv) Total quantity of waste disposed by land filling:

…………………………………………………………………………

a. no. of landfill sites used :

…………………………………………………………

b. Area used: ……………………………………………………

c. Whether Weigh bridge facilities available : Yes/No

a. Whether area is fenced : Yes/No

a. Lighting facility on site : Yes/No

(f) Whether equipment like Bulldozer, Compacters etc. available.

(Please specify) :---------------------------------- ------------------------------

a. Total Manpower available on site: --------------------------------------------

-

a. Whether covering is done on daily basis : Yes/No

i. Whether covering material is used and whether it is adequately

available : -------------------------------------

a. Provisions for gas venting provided : Available (Yes/No) /Not

available

a. Provision for leachate collection : Provisions made/ Provisions not

made

2. Storage facilities

(i) Area covered for collection of wastes : ---------------------------------------

(ii) no. of houses covered : ---------------------------------------

(iii)Whether house-to-house collection is practiced (if

yes, whether done by Municipality or through Private

Agency or Non-Governmental Organisation)

: ---------------------------------------

(iv) Bins : ---------------------------------------

Specifications Existing Proposed

(Shape & Size) Numbers for

future

---------------------------------------

a. RCC Bins (Capacity) :

b. Trolleys (Capacity) :

(c) Containers (Capacity) :

d. Dumper Placers :

e. Others, please specify :

(v)Whether all bins/collection spots are attended for

daily lifting of garbage

: Yes/No

(vi)Whether lifting of garbage from dustbins is

manual or mechanical i.e. for example by using of

front-end loaders (Please tick mark)

: Manual/Loader/Others, please

specify

3. Transportation

Existing number Actually

Required/Proposed

(i) Truck :

(ii) Truck-Tipper :

(iii) Tractor-Trailer :

(iv) Refuse-collector :

(v) Dumper-placers :

(vi) Animal Cart :

(vii) Tricycle :

(viii) Others (please specify) :

4. Whether any proposal has been made to improve solid wastes management

practices

4. Are any efforts made to call for private firms etc. to attempt for

processing of waste utilizing technologies like :

Waste Utilization

Technology

Proposals Steps taken

(Quantity to be

processed)

i. Composting :

ii. Vermiculture :

iii. Pelletisation :

iv. Others if any, Please specify :

6. What provisions are available and how these are implemented to check

unhygienic operations of :

i. Dairy related activities :

ii. Slaughter houses and unauthorised slaughtering :

iii. Malba (construction debris) lifting :

iv. Encroachment in Parks, Footpaths etc. :

7. How many slums are identified and whether these are provided with

sanitation facilities :

8. Are municipal magistrates appointed for Taking penal action : Yes/No

[ If yes, how many cases registered & settled during last three years (give year-wise

details)]

9. Hospital waste management

i. How many Hospitals/Clinics under the control of the Corporation:

ii. What methods are followed for disposal of bio-medical wastes ?:

iii. Do you have any proposal for setting up of common treatment facility for

disposal of bio-medical wastes :

iv. How many private Nursing Homes, Clinics etc. are operating in the city/town

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FORM - I

[See rules 10(1) and 10(4)]

APPLICATION FOR REGISTRATION OF A UNIT FOR MANUFACTURE OF

PLASTIC CARRY BAGS AND CONTAINERS

From: .......................................... ����������� �����������.(Name and full address of the occupier) To

The Member Secretary, .............���. Pollution Control Board/Pollution Control Committee ��������������. ��������������. Sir,

I/We hereby apply for registration under rule 10 of the Plastics Manufacture, Sale and Usage Rules, 1999.

PART � A

GENERAL

1.(a) Name of the unit and location of activity

(b) Address of the unit

(c) Registration required for manufacturing of : (i) Carry bag virgin (ii) Carry bag recycled (iii) Containers virgin (iv) Container recycled

(d) Manufacturing capacity

(e) In case of renewal of Registration previous Registration number and date

2.(a) Is the unit registered with DCSSI or Department of Industries of the State Government/Union Territory Administration?

(b) If yes, attach a copy.

3.(a) Total capital invested on the project

(b) Year of commencement of production

4 (a) List and quantum of products and by-products

(b) List and quantum of raw materials used

5 Furnish a flow diagram of manufacturing process showing input and output in terms of products and waste generated including for captive power generation and de-mineralized water

6 Minimum sizes of carry bags to be manufactured. (in any case it should not be less than 8� x 12�)

7. Status of compliance with rules 5,6,7 and 8

PART � B

PERTAINING TO LIQUID EFFLUENT AND GASEOUS EMISSIONS

8. (a) Does the unit have a valid consent under the Water (Prevention and control of Pollution) Act, 1974 (6 of 1974) If yes, attach a copy

(b) Does the unit have a valid consent under the Air (Prevention and Control of Pollution) Act, 1981 (14 of 1981) If yes, attach a copy

PART � C

PERTAINING TO WASTE

9.

Solid Wastes: (a) Total quantum of

generation (b) Mode of storage

within the plant (c) Provision made for

disposal

Place : Signature

Date : Designation

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FORM – I

[See rule 4(iii)]

FORM FOR FILING RETUNS OF SALE OF NEW BATTERIES AND

COLLECTION OF USED BATTERIES

[To be submitted by manufacturer/assembler /reconditioner by 30th

June (for the

period October-March) and 31st December (for the period April-September) every

year]

1. Name and address of the manufacturer /

assembler / reconditioner

2. Name of the authorised person and complete

address with telephone and fax numbers

3. Total number of new batteries sold during the

period October-March/April-September in

respect of the following categories

Category

(i)Automative

(a)Four Wheeler

(b)Two Wheeler

(ii)Industrial

(a)UPS

(b)Motive power

(c)Stand-by

(iii)others(inverters, etc.)

Number of battaries sold to

i. dealers

ii. bulk consumers

iii. OEM

iv. Any other party for replacement

Should be indicated separately

(i) No. of Batteries (ii)

Approximate weight

in Metric Tones

4. Name and full address of the designated

collection centres

5. Total number of used batteries of different

categories as at Sl. No. 3 collected and sent to

the registered recyclers*

• enclose the list of recyclers to who batteries have been sent for recycling.

Place_________________

Date__________________ Signature of the authorised person

FORM III

[see rule 6(iii)]

(to be submitted by importer of new lead acid batteries)

UNDERTAKING

To

The Member Secretary

State Pollution Control Board

1. I________________________ of M/s ____________________ hereby submit

that I am in the process of importing ______________________ (MT) of new

lead acid batteries.

2. I undertake that I shall collect back the used batteries as per the schedule

prescribed by the Government from time to time in lieu of the new batteries

imported and sold, and shall send these only to the registered recyclers. I

further undertake that I shall submit half-yearly returns as per item (iii) of rule

6 to the State Board and abide by their directions, if any.

Date :

Place : Signature of the Importer

Copy to : The concerned Customs Authority

FORM – VII

[see rule 8(iii)]

FORM FOR FILING RETURNS BY RECYCLERS OF USED BATTERIES

[To be submitted by recyclers by 30th

June and 31st December of every year]

1. Name and address of the recycler

2. Name of the Authorised person and full

address with telephone and fax number

3. Installed annual capacity to recycle used

battery scrap (in MTA)

4. Total quantity of used battery scrap

purchased from / sent for processing during

the period from October – March / April-

September

i. Quantity of used batteries sent

by / purchased from the

manufacturers

ii. Quantity of used batteries

purchased from the dealers

iii. Quantity of used batteries

purchased from auctioneers

iv. Quantity of used batteries

obtained from any other source

-

5. Quantity of lead recovered from the used

battery scrap (in MTA)

6. Quantity of recycled lead sent back to i. the manufacturer of batteries

ii. other agencies * -

• enclose list of other agencies.

Place ____________ Signature of the authorised person

Date ____________

FORM – VIII

[see rule 10 (2)(ii)]

FORM FOR FILING RETURNS BY RECYCLERS OF USED BATTERIES

[To be submitted by the bulk consumer to the Sate Board by 30th

June (for the

period October_March) and 31st December (for the period April-September)

every year]

1. Name and address of the bulk consumer

2. Name of the Authorised person and full

address with telephone and fax number

3. Number of new batteries of different

categories purchased from the manufacturer /

importer / dealer or any other agency during

October-March and April-September

Category :

i. Automative

a. four wheeler

(i) No. of Batteries (ii)

b. two wheeler

i. Industrial

a. UPS

b. Motive Power

c. Stand-by

i. Others

Approximate weight ( in Metric

Tonnes)

4. Number or used batteries of categories

mentioned in Sl. No. 3 and Tonnage of scrap

sent to manufacturer / dealer / importer /

registered recycler / or any other agency to

whom the used batteries scrap was sent

Place ____________ Signature of the authorised person

Date ____________

• Enclose list of manufacture / dealer / importer / registered recyclers /

or any other agency to whom the used batteries scrap was sent.

FORM – IX

[see rule 11 (ii)]

FORM FOR FILING RETURNS BY AUCTIONEER OF USED BATTERIES

[To be submitted by the auctioneer to State Board by 30th

June and 31st

December of every year]

1. Name and address of the auctioneer

2. Name of the Authorised person and full

address with telephone and fax number

3. Number of used batteries and total Tonnage

(of MT) available during the period from

October-March and April-September

4. Sources of the used battery scrap

5. Number of used batteries and total Tonnage

(of MT) auctioned during the period from

October-March and April-September

6. Number of used batteries and total Tonnage

of (MT) sent to the registered recyclers *

• enclose a list.

Place ______________

Date _______________