Application for the grant of a license to fill and store compressed gas in cylinder

1. Applicants Details:
(i) Name in which license required
(ii) Applicants full postal address with PIN Code
(iii) Director
(iv) Applicants telephone/ mobile number
(v) Applicants Email ID
2. Location of the premises where compressed gas to be filled and stored
(i) Survey No./ Plot No.
(ii) Town or Village
(iii) District
(iv) State
(v) PIN Code
(vi) Telephone Number
3. Name and Nature of each compressed gas proposed to be filled/ stored
Type of Gas Name of Gas No. of filling points Number of filled
cylinder/ kg of gas
proposed to be
stored
(i) Toxic N/A N/A N/A
(ii) Non Toxic & Non N/A N/A N/A
Flammable
(iii) Non-toxic & Methane (>90%), 01
Flammable Carbon Dioxide
(<4%), Oxygen
(<0.5%), Moisture
(<21 ppm), Hydrogen
Sulphide (<21 ppm),
(iv) Dissolved N/A N/A N/A
acetylene gas
(v) Non toxic and N/A N/A N/A
flammable
liquefiable gas other
than LPG
(vi) LPG N/A N/A N/A
4. Name and Nature of each compressed gas proposed to be filled/ stored (Applicable in case of
amendment)
Type of Gas Name of Gas No. of filling points Number of filled
cylinder/ kg of gas
proposed to be
stored
(i) Toxic N/A N/A N/A
(ii) Non Toxic & Non N/A N/A N/A
Flammable
(iii) Non-toxic & N/A N/A N/A
 Flammable
(iv) Dissolved N/A N/A N/A
acetylene gas
(v) Non toxic and N/A N/A N/A
flammable
liquefiable gas other
than LPG
(vi) LPG N/A N/A N/A
5. Number of license held for the premises (Not applicable in N/A
new cases)
6. Particulars of NOC issued by District Authority (where
applicable)
7. Particulars of CNG Dispensers/ Cascade & Compressors
i. Particulars of BioCNG Compressors
ii. Particulars of BioCNG Cascade

I hereby declare that statements made above have been checked up by me and are true and I undertake
to abide by the norms and conditions of the license, which will be granted to me.

Date of Application: _________________ ________________________________

________________________________

(Signature and Designation of the Applicant)

Requisite Fee:

DD drawn on any nationalized bank or Scheduled bank in favor of “Controller of Explosives, Faridabad”

S.No. Particular Rupee

1 To fill compressed gas in cylinder 5000.00
2 To store compressed gas in cylinder in storage shed (for 100-500 cylinders) 4000.00
3 Issue of filling permission (Scrutiny fee for 100-500 cylinders) 3000.00
Total 12000.00

Scope of Work – CLIENT END:

1. No Objection Certificate (Annexure I)

I. As per point (6) in the form NOC is to be issued by District Authority (DM/SDM) to an applicant
for a license to store compressed gas in cylinders in storage shed attached to filling premises for
storage of flammable, toxic or corrosive gases for the purpose of sale or trading and not for own
use.
II. The applicant shall apply to District Authority with two copies of site plan showing the location
of the premises proposed to be licensed. If District Authority is satisfied, shall grant a No
Objection Certificate to the applicant receiving a license for the above purpose at the site
proposed.
III. Every certificate issued by District Authority shall be accompanied by a copy of duly endorsed
(official seal) plan of the proposed site.

2. Documentary evidence in support of legal physical possession of the premises proposed to be

licensed vetted by local administration (Tehsil Office/ Panchayat)

3. An undertaking stating that all necessary clearances from revenue, fire and local administration have
been obtained (Required at the time of grant of license)

4. Documentary evidence of certificate of change land use.

Scope of Work – Geon:

1. Four copies of specifications and land plan (same as approved from District Authority) (To be fulfilled
by Geon)

2. HAZOP Study/ Disaster Management Plan for flammable gases.