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To
The Member Secretary,
Tamil Nadu Pollution Control Board,
76, Mount Salai,
Guindy, Chennai - 600032
Sir,
I / We hereby apply for authorisation / renewal of authorisation under the Sub-rule (3)
of Rule 5 of the Hazardous Waste (Management, Handling and Transboundary Movement)
Rules, 2008 for collection / reception / treatment / transport / storage / disposal of hazardous
waste.
For Office Use Only
:
Code No
(a)
(b)
(c)
(a)
(b)
(a)
(b)
(c)
(a)
(b)
Part
8
(a)
(b)
(c)
(d)
9
Yes / No
:
:
B: Hazardous waste
Hazardous Waste :
Type of hazardous wastes generated as
defined under these Rules
Quantum of hazardous waste generated
Sources and waste characteristics (Also
indicate wastes amenable to recycling, reprocessing and reuse)
Mode of storage within the plant, method
of disposal and capacity. (provide details)
:
:
:
:
10
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
Place :
Date :
:
:
:
:
:
:
:
Signature :
Designation :
ANNEXURE
Details of hazardous wastes generated
Sl
No
Waste
Category
Description of waste
Quantity of waste in
Tonnes
Annual
Accumulated
generation as on date
Source of waste
Mode of storage
within the plant
Method of disposal
Signature
Note :
1. Quantity of waste shall be furnished only in Tonnes.
2. Characteristics of waste to be enclosed separately along with other necessary enclosures.