West Bengal Pollution Control Board
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Hazardous Waste Authorization



Application Form

GENERAL INFORMATION
Applicant Name:* Date Of Application:
(DD/MM/YYYY)
Place Of Application:* Name Of Unit:*
Address Of Unit :
Street/Road Name: Post Office:*
District:* Pin Code:*
Telephone: Fax:
Email: Local Body:*
Police Station:*

UNIT DETAILS
Unit Type :
Type Of The Unit:*
 
Authorization Required For:* Collection   Transport   Reception  
Storage   Treatment   Disposal  
Industry Works:*
 
Renewal Of Authorization :*
Previous Authorization No.: Previous Authorization Date:
(DD/MM/YYYY)
 
Total Invested Capital:*
(Land+Building+Plant+Machinery-PCSCost)
Year Of Commencement Of Production:*
 
List and Quantum
Of Products and Byproducts
(MT/Month):
List and Quantum
Of Raw Materials
(MT/Month):

HAZARDOUS WASTES
 
Whether Generating Hazardous Waste :*
 
Hazardous Wastes And Mode Of Disposal:
Serial No.* Waste Description* Waste Category Schedule* Waste Stream Waste Type* Waste Quantity(MT/yr)* Mode of Storage* Mode of Treatment* Mode of Disposal* Disposal Quantity (MT/Year)* Name Of Unit Address Of Unit
Street/ Road Name Post Office District State
1
2
3
4
5
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Hazardous Chemicals
Isolated Storage Involved:* Details (If Yes):

TREATMENT,STORAGE AND DISPOSAL FACILITY
(To be filled only by the Units having own TSDF)
 
Location Of Site: Name Of Waste Processing Technology:
Details Of Processing Technology:  
Waste Processed Details
Type Of Waste To Be Processed Per Day: Quantity :
 
Site Clearance From Local Authority Available:  
Utilization Program For Waste Processed:  Method Of Disposal:
Quantity Of Waste To Be Disposed Per Day: Nature Of Waste:
Composition Of Waste: Methodology and Operational Details Of Land Filling/Incineration:
Measures To Be Taken For Prevention and Control Of Environmental Pollution Including Treatment Of Leach Ate: Investment On Project:
Expected Returns: Measures To Be Taken For Safety Of Workers:
 

WASTE RECEIVED (Transportation By Waste Generator)
(To be filled only by the Units having own TSDF)
No Of Members :- (>0)
Members that have opted for waste transport on their own :- (>=0)
Members that have opted for waste transport by the Operator :- (>=0)

WASTE TYPE
(To be filled only by the Units having own TSDF)
Waste Type
Qty(MT/Year)
Recyclable
Incinerable
Disposable
Intractable
Total

WASTE COLLECTED (Transportation byOperator)
(To be filled only by the Units having own TSDF)
Waste Type Qty(MT/Year)
Recyclable
Incinerable
Disposable
Intractable
Total

Total of Waste :-


WASTE TREATED & DISPOSED
(To be filled only by the Units having own TSDF)
Process Actual(MT/Year)Capacity(MT/Year)
Stabilization
Incineration
Landfilling (Excluding Incineration Ash)
Landfilling (Incineration Ash)
Total

LANDFILL DETAILS
(To be filled only by the Units having own TSDF)
No of closed Cells :- Total Capacity(MT) :-
No. of Operating Cells :- Total Capacity(MT) :-
Disposal Details For Recyclable Waste :-

LIST OF ENCLOSURES

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Please memorise the password and the application Number for future Communation. This is Important
 Create Application Key :*  Confirm Application Key :*