FORM - 1 FOR AIR CONSENT
(See Rule 13)
(To be submitted in Duplicate)
APPLICATION FOR CONSENT FOR EMISSION/CONTINUATION OF EMISSION UNDER SECTION 21 OF THE AIR (PREVENTION AND CONTROL OF POLLUTION ACT, 1981)
Date :
From :
.................................
.................................
.................................
To,
The Member Secretary,
M.P. Pollution Control
Board,
Paryawaran
Parisar, E-5,
Arera
Colony,
I/We hereby apply for
Consent/Renewal of consent under Section 21 of the Air (prevention and Control
of Pollution) Act 1981 (No. 14 of 1981) to bring into use a new/altered "Stack
for the discharge of Emission/to begin to make new discharge of emission/to
continue to discharge emission" from stack in Industry owned by
..................................................................................... The relevant details are as below
:-
1.
Full name of
application, degsignation with address &
Telephone No. :
......................................................................................................
......................................................................................................
......................................................................................................
2.
Name of full
time Directors with address & Telephone No. :
......................................................................................................
......................................................................................................
3.
Full factory
address (with name of Plot/Premises) & Telephone No. :
......................................................................................................
......................................................................................................
......................................................................................................
4.
Date of
commissioning of factory or proposed date of commissioning of
Factory:
5.
Capital
investment made (Rs. In Lakhs)
6.
Total No. of
Employees :
7. (A) Licensed
Annual Capacity of the factory :
(B)
Attach a brief
of the manufacturing process along with a flow, diagram and the position of
corresponding Stack on the Plot plan.
8. State the
number of boilers, heaters, furnaces installed in the factory along with their
capacity type/quantity of fuel used and emission from the stacks .............
..........................................................................................................
..........................................................................................................
9.
Stack's
details :
(a) Number of
Stacks :
(b) Natural
draft/I.D.Fan/F.D. Fan :
(c) Material of
construction of stack :
(d)
Hight of Stacks :
(i) Above ground level (Meters) :
(ii) Above factory
room (Meters) :
10.
Attach
information on Air Pollution Control Equipment in respect of each of the Stacks
listed in item 9 above.
(a) Name of
equipment :
(b) Existing or
Proposed and for which :
pollution and date of installation
(c) Reduction
efficiency guarantteed by :
the manufacturer
(d) Quantity
& Quality of current/expected :
emission
(e) Whether the
industry works in general :
shift or 2 shift or round the clock
(e)
Whether
monitoring is being done or :
proposed
11.
Attach
information on compliance of emission with respect to the Standard.
12.
I/We declare
that the information furnished above is correct to the best of my/our
knowledge.
13.
I/We hereby
submit that in case of change either of the point of the emission or its
quality, a fresh application for consent shall be made until such consent is
granted no emissions shall be made.
14.
I/We hereby
agree to submit the State Board an application for renewal of consent one month
in advance of the date of expiry of the consented period for stack emission if
to be continued thereafter.
15.
I/We undertake
to furnish any information within one months its being
called by the State Board.
I/We enclosed herewith cash Receipt No. .................................. Bank
Draft
No
..............................................dated ..................... for Rs. ..............
(Rupees
............................................................................................)
in favour of Madhya Pradesh Pollution Control Board, as has
been payable
under Section 21 of the Act.
Yours
Faithfully,
Signature of the Applicant
Signature
of the Applicant
Accompaniments :
1.
Site plan, lay
out & to be sheet.
2.
A copy of
Project Report.
3.
Name of Local
Body/panchayat.
4.
List of
industries, villages rivers & lakes and other
Salient feature and distances from site, within a radius of 5/10 Km. In case of
medium/large industry.
Note :
1.
Any applicant
knowingly giving incorrect information of suppressing any information
pertaining there to shall liable to be punished under the Act.
2.
"Strikeout
which is not relevant".