FORM 1
[See rule 6 (1)]
Application required for grant/renewal of authorisation for generation or collection or
storage or transport or reception or recycling or reuse or recovery or pre-processing or
co-processing or utilisation or treatment or disposal of hazardous and other waste
Part A: General (to be filled by all)
1. (a) Name and address of the unit and location of facility :
(b) Name of the occupier of the facility or operator of disposal facility with
designation, Tel, Fax and e-mail:
(c) Authorisation required for (Please tick mark appropriate activity or activities:
(i) Generation
(ii) Collection
(iii) Storage
(iv) Transportation
(v) Reception
(vi) Reuse
(vii) Recycling
(viii) Recovery
(ix) Pre-processing
(x) Co-processing
(xi) Utilisation
(xii) Treatment
(xiii) Disposal
(xiv) Incineration
(d) In case of renewal of authorisation previous authorisation numbers and dates and provide
copies of annual returns of last three years including the compliance reports with respect to
the conditions of Prior Environmental Clearance, wherever applicable:
2. (a) Nature and quantity of waste handled per annum (in metric tonne or kilo litre)
(b) Nature and quantity of waste stored at any time (in metric tonne or kilo litre)
3. (a) Year of commissioning and commencement of production:
(b) Whether the industry works:
(i) 01 Shift
(ii) 02 Shifts
(iii) Round the clock
4. Provide copy of the Emergency Response Plan (ERP) which should address procedures for
dealing with emergency situations (viz. Spillage or release or fire) as specified in the
guidelines of Central Pollution Control Board. Such ERP shall comprise the following, but
not limited to:
Containing and controlling incidents so as to minimise the effects and to limit
danger to the persons, environment and property
Implementing the measures necessary to protect persons and the environment;
Description of the actions which should be taken to control the conditions at events
and to limit their consequences, including a description of the safety equipment and
resources available;
Arrangements for training staff in the duties which they are expected to perform;
Arrangements for informing concerned authorities and emergency services; and
Arrangements for providing assistance with off-site mitigatory action.
5. Provide undertaking or declaration to comply with all provisions including the scope
of submitting bank guarantee in the event of spillage, leakage or fire while handling the
hazardous and other waste.
Part B: To be filled by hazardous waste generators
1. (a) Products and by-products manufactured (names and product wise quantity per annum):
(b) Process description including process flow sheet indicating inputs and outputs (raw
materials, chemicals, products, by-products, wastes, emissions, waste water etc.) Please
attach separate sheets:
(c) Characteristics (waste-wise) and Quantity of waste generation per annum:
(d) Mode of management of (c) above:
i. Capacity and mode of secured storage within the plant;
ii. Utilisation within the plant (provide details);
iii. If not utilised within the plant, please provide details of what is done with this
waste;
iv. Arrangement for transportation to actual users/ TSDF;
(e) Details of the environmental safeguards and environmental facilities provided for safe
handling of all the wastes at point (c) above;
2. Hazardous and other wastes generated as per these rules from storage of hazardous
chemicals as defined under the Manufacture, Storage and Import of Hazardous Chemicals
Rules, 1989
Part C: To be filled by Treatment, storage and disposal facility operators
1. Provide details of the facility including:
(i) Location of site with layout map;
(ii) Safe storage of the waste and storage capacity;
(iii) The treatment processes and their capacities;
(iv) Secured landfills;
(v) Incineration, if any;
(vi) Leachate collection and treatment system;
(vii) Fire fighting systems;
(viii) Environmental management plan including monitoring; and
(ix) Arrangement for transportation of waste from generators.
2. Provide details of any other activities undertaken at the Treatment, storage and disposal
facility site.
3. Attach a copy of prior Environmental Clearance.
Part D: To be filled by recyclers or pre-processors or co-processors or users
of hazardous or other wastes
1. Nature and quantity of different wastes received per annum from domestic sources or imported
or both:
2. Installed capacity as per registration issued by the District Industries Centre or any other
authorised Government agency. Provide copy:
3. Provide details of secured storage of wastes including the storage capacity:
4. Process description including process flow sheet indicating equipment details, inputs and
outputs (input wastes, chemicals, products, by-products, waste generated, emissions, waste
water, etc.). Attach separate sheets:
5. Provide details of end users of products or by-products:
6. Provide details of pollution control systems such as Effluent Treatment Plant, scrubbers, etc.
including mode of disposal of waste:
7. Provide details of occupational health and safety measures:
8. Has the facility been set up as per Central Pollution Control Board guidelines? If yes, provide a
report on the compliance with the guidelines:
9. Arrangements for transportation of waste to the facility:
Signature of the
Applicant
Date………………..
Place……………….
Documents required:-
1. Application Form duly completed in all respect.
2. Authorization Fee.
3. Undertaking in prescribed format duly signed by the applicant.
4. Photographs of Display Boards 1 & 2.
5. Photographs of Containers.
6. PAN Card of the Industrial Unit/ Proprietor/HCU except Govt. Owned /PSU agencies.
7. Original Authorization letter except in case of individual proprietary concern.
