Format No:-

Realese Date:-
Rev No/Rev Date:-
HAZARDIOUS MATERIALS DISPLAY SIGN BOARD Effective From:-
Address of the Industry :-
Product manufactured & It’s annual capacity
Date of Issue of Consent Consent to Establish Consent to operate Consent to Renewal
Under Water Act: -
Under Air Act: -
Date of validity of latest renewal consent order Water Act Air Act

Type of Hazardous Wastes Generation per Month Storage as on Today Mode of Disposal
Hazardous Carbonaceous Wastes
Hazardous Non-Carbonaceous Wastes
Hazardous Non-Carbonaceous Wastes

Name of Hazardous Chemicals stored & It’s storage capacity Name of Chemical Maximum Storage
Not applicable Not applicable
Water Pollution Industrial Effluent Generation Treatment System Installed Details of disposal/ discharge point
Not applicable RO Plant Not applicable
Treated Effluent Quality Parameters Analysis Report Prescribed Standards
Total Suspended Solids 100 mg/L
BOD 30 mg/L
COD 250 mg/L
Oil & Grease 10 mg/L
Source of Air Pollution Air Pollution Control System Provided Emission Monitoring Report Prescribed Standard
Adequate stack height is provided to the Noise Level: Day Time: 75
D.G. Set : 125 KVA - 1 No. dB (A) Leq Night Time: 70 dB (A) Leq
D.G. Set.