MAHARASHTRA POLLUTION CONTROL BOARD

REGIONAL OFFICE / SUB REGIONAL OFFICE

No. : MPCB/ Date: /02/2008.
Report for processing of Application for grant of Consent / Authorization
1 Type of Industry :

2 Name of Industry and
Address




3 Application for
4 Date of receipt of application



5 Capital Investment

: Existing
Proposed
Total

6 Category of Industry
7 Year of Commissioning of
the factory
:
8 Details of previous consent No. --
Date --
Validity --
9 Consent fee paid Rs.
10 Consent applied up to
Location :

a) In Approved Industrial
Area

:
b) In Sensitive Area
If yes, Name of sensitive
area
:
c) In case of any other
Specific area
:
d) Distance from river / high
tide line
(Crowfly distance)
:
11
e)Distance from NH/SH Way


:




12) Product & special by-products

Sr.
No.
Name Previous level of
production
Proposed level of
production
Total proposed
production




13) In case of expansion please
mention whether expansion is
due to
:

14) Manufacturing process in brief
15) Raw material with quantity (In
MT/Month)
:
a) Are they using any Hazardous
waste or raw material?
b) Are they using and Hazardous
chemicals or raw materials?
:



16. Water Pollution Control:
Water Intake,
cum
Consumption
and losses, cum
Generated
effluent
cum
Recycle and
reuse, cum
Net discharge-
able Effluent,
cum
E* P* E P E P E P E P
(i) Domestic
(ii) Industrial
1. Cooling
2. Tail race Water


(iii) Industrial process
Generating
biodegradable
waste water

(iv) Industrial process &
floor washing
generating non-
biodegradable waste
water

(v) Other uses like
gardening etc.

E= Existing unit, P= Proposed Unit

Is there any increase in effluent quantity
generated.
If yes, justification for increase if effluent
quantity
:



A. Details of Effluent treatment
arrangement provided including:
Design capacity
Unit processes
Adequacy
Monthly O&M cost
:
B. Details of effluent disposal
arrangement provided including:
CETP
River/stream/Creek
Municipal sewer
Land, (area available for land
disposal)
:
C. Details of any additional effluent
treatment & disposal arrangements

:


17. Analysis report of treated waste Water:
(Last 3 J VS reports shall be submitted. A copy of track record register shall also be
enclosed with visit reports)*
Result of vigilance sample collected on Parameters Standards Prescribed
Date Date Date
Sample Collected by
pH 5.5 to 9.0
Suspended Solids Not exceed 100 mgl/l.
B.O.D. Not exceed 30 mgl/l.
C.O.D. Not exceed 250 mgl/l.
Oil & Grease Not exceed 10 mgl/l.
D.O. Not exceed 5 mgl/l.
T.D.S. Not exceed 2100 mgl/l.

18. Air Pollution Control:-
Fuel Consumption

a) Type of fuel used & quantity


b) Details of stack
Height
(in meters)
Diameter
(in meters)
Stack attached to




Type of Pollutant Process

c) Other sources of
process emissions

(i) D.G. Sets with
capacities in KVA

(ii) Details of Air-
Pollution Control
Equipment installed.

(iii) Additional Air
Pollution control
measures proposal to
be taken



19. JVS results of air emissions:
Result of vigilance sample collected on Parameters Standards Prescribed
Date Date Date

20. Hazardous Waste:-
Sr.
No.
Category and type
of waste
Generation Prescribed Disposal


In case of imported Hazardous Wastes
are used as raw material Details about
the permission obtained from MoEF
:




21. Non-Hazardous Solid Waste:
Sr.
No.
Type of waste Generation Prescribed
Disposal
Quantity disposed in last one year





22. Hazardous chemicals:

(i) Details of the storages

:
(ii) Whether permission form concerned
authorites like Directorate of Industrial Safety
& Health Local Body, Explosive Department is
taken.
:
(iii) Whether onsite disaster management plan is
prepared.
:

(iv) Is public liability insurance obtained? :

23. Water Cess:

(i) Category of industry as per Schedule-II of
Water Cess Act, 1977.
:
(ii) Whether meters have been fixed at different
places of water consumption?
:
(iii) Whether water cess has been paid by the
industry up to date
:
(iv) Whether the Environment (Audit) Statement
has been submitted by the company, If yes,
upto year.
:



24. Tree Plantation:
(i) Total open space available with the factory :
(ii) Tree plantation area :
(iii) No. of trees planted :



25. Legal Record:
a) Whether Legal action has been taken
against the industry? If yes give details

(b) Details of B.G. Available


26. Remarks:
a. Whether in conforming area? :
b. Whether product is permissible or not? :
c. Operation & maintenance of the pollution
control system (Treatment & Disposal)
:
d. Adequacy of pollution control system :
e. Any other, specific remark



f. Visited by (Enclose latest visit report)


27. Recommendations:

a) Whether consent may be granted ? :

b) If yes, period of consent :

c) If no, further action proposed :


28. Details of consent fee paid :
D.D. No. Date Bank Amount



Encl: As above & consent application.



Regional Officer/Sub-Regional Officer,

Encl: As above & consent application.

Remarks of HQ: