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:		Local Body:*
District:*		Post Office:*
Police Station:*		Pin Code:*
Telephone:		Fax:
Email:

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

Hazardous Chemicals
Add More

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 COLLECTED (Transportation byOperator)
(To be filled only by the Units having own TSDF)

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

Guideline for uploading required documents:
1. Prepare one file in PDF format for each of the following.
Location map and site plan (plant layout) Hazardous Waste storage and handling system/procedure (with photographs) Copy of Consent to Establish certificate Copy of Consent to Operate certificate (in case Consent to Operate has not been obtained, submit copy of forwarding letter showing application has been submitted) Copy of challan showing last water cess payment Copy of Agreement of Membership of Common HW Treatment Storage Disposal Facility (CHWTSDF) in case the unit generates incinerable and disposable wastes Photograph of one English Environmental Information display board of size 6’ x 4’ installed outside the main gate Photograph of one Bengali Environmental Information display board of size 6’ x 4’ installed outside the main gate In case of application for renewal of Authorisation, submit a Compliance Report w.r.t. previous authorisation
2. Make a ZIP file (Size 10 MB Maximum) with all the documents.
3. Upload the ZIP file here:

Please memorise the password and the application Number for future Communation. This is Important

Create Application Key :* Confirm Application Key :*