Consolidated Statement on various Environmental Aspects for Industrial Projects

Important Note before filling the form: 1. Fill the form in the same format (i.e. Font: Times New Roman and font size: 12) 2. Do not edit / delete the columns if its not applicable 3. Send soft copy to the mahaseac@gmail.com and seiaa.mah@gmail.com in the word format (doc file) Sr. Particulars No. 1 Name of the Project 2 Name, address, e-mail & contact number of Proponent Commitment On

Name: Address: Telephone number: Mobile number: Email ID: Name, address, e-mail & Name: contact number of Address: Consultant Telephone number: Mobile number: Email ID: Accreditation of QCI NABET List for the proposed category of the project consultant (NABET Accreditation) New Project / Expansion in existing project/ Modernization/ Diversification in exiting project If expansion/ Diversification, whether environmental clearance has been obtained for existing project (If yes, enclose a copy with compliance table)

Activity schedule in the EIA Notification Area Details Name of the Notified Industrial area / MIDC area TOR given by SEAC? (If yeas then specify the meeting) Estimated capital cost of the Project (including cost for land, building, plant and machinery separately) Location details of the project : Total plot area (sq. m.): Built up area (Sq. m.):

8 9

10

11

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Latitude Longitude Location Elevation above Mean Sea Level (metres)

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Distance from Protected Areas / Critically Polluted areas / Eco-sensitive areas / inter-State boundaries Raw materials (including process chemicals, catalysts, & additives).

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List of raw materials to be used

Physical and chemical nature of raw material

Quantity (tonnes/ year) full production capacity

Source of materi als

Means of transportat ion (Source to storage site) with justification

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Production details Name of Products, Existing By products and (T/Year) Intermediate Products Proposed activity (new/ modernization / expansion) Total (T/Year)

(T/Year) Main Products By-Products Intermediate Products 16 17 Process details manufacturing details Rain Water Harvesting (RWH) / Level of the Ground water table Size and no of RWH tank(s) and Quantity Location of the RWH tank(s) Size, nos of recharge pits and Quantity Budgetary allocation (Capital cost and O&M cost)

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Total Water Requirement

Total water requirement: Fresh water (CMD): Recycled water (CMD): Use of the water: Process (CMD): Cooling water (CMD): DM Water (CMD): Dust Suppression (CMD): Drinking (CMD): Green belt (CMD): Fire service (CMD): Others (CMD):

&

Source

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Storm water drainage

Natural water drainage pattern quantity of storm water Size of SWD Amount of sewage generation (CMD) Proposed treatment for the sewage Capacity of the STP (CMD) (If applicable)

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Sewage generation and treatment

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Effluent characteristic Sr. No. Parameters (pH, BOD, COD, heavy metal, etc) Inlet effluent Characteristic Outlet effluent Characte ristic Effluent discharge standards (CPCB /

MPCB) 1 2

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ETP details

Amount of effluent generation (CMD) Capacity of the ETP (CMD) Amount of treated effluent recycled (CMD): Amount of water send to the CETP (CMD): Membership of the CETP (If require): If yes then attach the letter submit the letter

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Note on ETP technology to be used Disposal of the ETP sludge (If applicable) Solid waste Management

Sr. No 1

Source Raw water treatment plant ETP Process Spent Catalyst Oily Sludge Others like Battery waste, e waste etc (Pl. Specify)

Qty (TPM)

Form Composition (Sludge / Dry / Slurry etc.)

2 3 4

If waste(s) contain any hazardous/toxic substance/radioactive materials or heavy metals then provide quantity, disposal data and proposed precautionary measures. What are the possibilities of recovery and recycling of wastes?

 Possible users of solid waste Method of disposal of solid waste 26 Atmospheric Emissions (Flue gas characteristics SPM, SO2, NOx, CO, etc.)

Sr. No . 1 2 3 4 5

Pollutant

Source of Emission

Emission rate (kg/hr)

Concentration in flue gas (g/m3)

SPM SO2 NO x CO Others Stack No. Height from ground level (m) Internal Diameter (Top)(m) Emission Rate Temp. of Exhaust Gases

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Plant (All the stacks attached to Section & units process units, Boilers, captive power plant, D.G. Sets, Incinerator both for existing and proposed

Stack emission Details:

1st & so on

activity). Please indicate the specific section to

which the stack is attached. e.g.: Process section, D.G. Set, Boiler, Power Plant, incinerator etc. Emission rate (kg/hr.) for each

pollutant (SPM, SO2, NOx etc. should be specified

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Emission Standard

Pollutants (SPM, SO 2, etc)

Emission Standard Limit (mg/Nm3)

Proposed Limit (mg/Nm3)

MPCB Consent (mg/Nm3)

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Ambient Air Quality Data

Pollutant

Permissible Standard

Proposed Concentration (in g/m3)

Remarks

SPM RPM SO2 NO x CO

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Details of Fuel to be used: Sr. No Fuel Daily Consumption (TPD/KLD) Existing 1 2 3 4 5 6 7 Gas Naphtha HSD Fuel Oil Coal Lignite Other (Pl. specify) Source of fuel: Mode of transportation of fuel to site: Proposed Calorific value (Kcals /kg) % Ash % Sulph ur

31 Energy

Power supply: Existing power requirement: Proposed power requirement: DG sets: Number and capacity DG sets to be used (existing and proposed) Details of the non-conventional renewable energy proposed to be used :

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Green Belt Development

Green belt area (Sq. m.): Number and species of trees to be planted Number, size, age and species of trees to be cut, trees to be transplanted

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Details of Pollution Control Systems:

Sr. No.

Existing pollution control system Air Water Noise

Proposed to be installed

1 2 3

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Environmental Management plan Budgetary Allocation

4 Solid Waste Capital cost (With break up): O&M cost (With break up): Recurring Cost Capital per annum Cost Air Pollution Control Water Pollution Control Noise Pollution Control Environment Monitoring and Management Reclamation borrow/mined applicable)

Sr. No. 1 2 3 4

area

(If

6 7 8 9

Occupational Health Green Belt Solid waste management Others ( Pl. Specify) Total Period of data collected Details of the primary data collection (i.e. location of the sample collection, number of visit, etc) Details of the secondary data collection (i.e. Source and year of data)

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EIA Submitted ( If yes then submit the salient features)

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Potential hazard and mitigation measures Conclusion of the EIA study Public hearing report (If Date of the public hearing public hearing conducted Name of the news paper in which the advertisement appeared then submit the salient (Please attach the copy) features) Location of the public hearing Number of people attended the hearing Objection(s) / Suggestion(s) if any Air pollution, water pollution issues in the project area, If any 38 . Storage of chemicals (inflammable/explosive/hazardous/toxic substances)

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Sr. Name No.

Number Capacity Physical and Consumption Maximum Source Means of (TPD) Chemical (in TPD) Quantity of of Storages Composition of storage Supply transportation at any point of time

Declaration I hereby declare that no work has been initiated for the said project.

Date: Place:

Name & Signature of the project proponent

Name & Signature of the consultant