Substituted by G.S.R.717(E), dated 27.7.1989 — CONTROL OF POLLUTION) ACT, 1974

1 Substituted by G.S.R.717(E), dated 27.7.1989 Name, Address and Telephone Nos. of Applicant. (the full list of individuals partners persons Chairman (full-time or part-time Managing Directors, Managing Partners Directors (Full time or part-time) other kinds of office bearers are to be furnished with their period of tenure in the respective office with telephone Nos. and address). Address of the Industry: (Survey No. Khasra No. location as per the revenue records Village Firka Tehsil District. Police Station or SHO jurisdiction of the First-Class Magistrate). Details of commissioning etc.:- (a) Approximate date of proposed commissioning of work. (b) Expected date of production: Total number of employee expected to employed. Details of licence, if any obtained under the provisions of Industrial Development Regulations Act, 1951. Name of the person authorised to sign this form (the original authorisation except in the case of individual proprietary concern is to be enclosed). (a) attach the list of raw materials and chemicals used per month. (b) Licence Annual Capacity of the Factory/Industry. State daily quantity of water in kilolitres utilised and its source (domestic/industrial process boiler Cooling others). (a) State the daily maximum quantity of effluents quantity and mode of disposal (sewer or drains or river). Also attach analysis report of the effluents. Type of effluent quantity in kilolitres Mode of disposal. (i) Domestic (ii) Industrial. (b) Quality of effluent currently being the discharged or expected to be discharged. (c) What monitoring arrangement is currently there or proposed. State whether you have any treatment plant for industrial, domestic or combined effluents. If yes attach the description of the process of treatment in brief. Attach information on the quality of treated effluent vis-a-vis the standards. State details of sold wastes generated in the process or during waste treatment. Description ............. Quantity ............. Method ............. Method of disposal I/We further declare that the information furnished above is correct to the best of my/our knowledge. I/We hereby submit that in case of change either of the point of discharge or the quantity of discharge or its quality a fresh application for CONSENT shall be made and until such CONSENT is granted no change shall be made. I/We hereby agree to submit to the Central Board an application for renewal of consent one month in advance of the date of expiry of the consented period for outlet/discharge if to be continued thereafter. I/We, undertake to furnish any other information within one month or its being called by the Central Board. I9. I/We, enclose herewith cash receipt No./bank draft No. ___________ dated _____ for Rs.___________________(Rupees________________________________________) in favour of the Central Pollution Control Board, New Delhi, as fees payable under section 25 of the Act. Yours faithfully, signature of the applicant Note: * Strike out which is not relevant. FORM XIV CENTRAL POLLUTION CONTROL BOARD NOTICE OF INSPECTION [See Rule 33(2)] Chairman Shri Member-Secretary Shri ____________________________ ________________________________ ________________________________ No. _____________________________ Dated ___________________________ To ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ TAKE NOTICE that for the purpose of enquiry under sections 25/26 the following officers Or the Central Board namely:- (i) Shri _______________________________________________________________ (ii) Shri_______________________________________________________________ (iii) Shri_______________________________________________________________ and the persons authorised by the Board to assist them shall inspect the (a) Water works (b) Sewage Works (c) Waste treatment Plant (d) Factory (e) Disposal system (f) Any other parts thereof or pertaining thereto under management/control on date(s) ____________________________ between ____________________________ hours when all facilities requested by them for such inspection should be made available to them on the site. Take Notice that refusal or denial to above stated demand made under the functions of the Central Board shall amount to obstruction punishable under section 42 of the Act. By order of the Board. Member-Secretary. Copy to:

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