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FORM NO. 1 AND QUESTIONNAIRE
(For Submission)
APPLICATION FOR PERMISSION TO CONSTRUCT NEW FACTORY, TO EXTEND EXISTING
FACTORY AND TO TAKE INTO USE AN EXISTING BUILDING AS A FACTORY
GENERAL NOTES:
1. Form No. 1.
2. A flow-chart of the manufacturing processes to be carried out in the proposed factory
supplemented by a brief description of the processes in its various stages.
3. Plans in duplicate, drawn to scale, showing –
(a) The site of the factory and immediate surroundings including adjacent
buildings and other structures, roads, drains etc.
(b) The plans, elevation, vies and cross-sections of various buildings, indicating all
the relevant details relating to natural lighting, ventilation and means of escape
in case of fire or in emergencies.
(c) The plans, showing clearly the position of carious plants, aisles, machinery‟s
etc. indicating the distances between the adjacent machines and between
machines and the adjacent walls or pillar etc. the passage ways through the
working room shall also be shown clearly on plans.
(d) All the departments and sections should be clearly mentioned on plans and the
number of workers likely to work in such departments and/or sections should
also be mentioned on plans.
(e) Such other particulars as the Chief Inspector may require.
Notes:- (i) For additions and alterations to the existing factories the proposed
changes should be shown in the following distinctive colours:-
(a) Proposed work in Pink Colour, and
(b) Proposed demolition in Yellow Colour.
(ii) All the drawings should be suitably dimensioned. This office cannot undertake
their scaling.
(iii) The site or Block plans must be drawn to a minimum scale of 1 : 500. Scale for
building plans and cross section must be drawn to a minimum scale of 1 : 100.
Here affix Court Fee
Stamp of Rs. 2.50
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(iv) Wherever the word „section‟ appears the relevant section the Factories Act,
1948 is meant; similarly wherever the word „rule‟ appears the relevant rule
under the Maharashtra Factories Rules, 1963 is meant.
1. General :
(i) Have the site and plans of your factory building/extension been approved by the
Municipality or the local health authorities? If so, please send a copy of the approval letter.
(ii) Are the necessary drawings as mentioned in the General Note submitted in duplicate with
the principal dimensions shown in the drawings? (Drawings should be self-explanatory.)
(iii) Is Statistical Form attached, submitted, duly filled in for all work-rooms, go-downs, offices
etc. Which are proposed to be constructed or extended?
(iv) Has the work commenced?
(v) What will be the total maximum number of workers employed per day (including all shifts)
in the entire factory?
Males:
Females:
(vi) What will be the maximum number of workers working in the entire factory at any one
time
Males:
Females:
(vii) Are all work-rooms not more than 18 meters wide window on both the outer (longer)
walls?
Note : If not provision of efficient forced draught ventilation will be insisted upon in respect of
any such work-room and details of this, viz., capacity of the forced draught fans, resultant
air changes per hour, proposed to be obtained should be furnished.
(viii) Are there any hot processes or those giving off fumes and/or dust proposed to be carried
out? If so, please indicate how the nuisance is proposed to be eliminated or minimized?
Note : Galvanized iron sheet or asbestos cement sheet is not acceptable as roof material unless it
is covered with tiles or a false ceiling of heat resisting material provided below or at
increased minimum heights as approved by the Chief Inspector of Factories.
2. Roof:
(i) Type of roof.
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(ii) Material to be used for roof covering (It should be noted that the minimum height from
floor to the roof should not be less than 3.75 metres.)
Note :- Galvanised iron sheet or asbestos cement sheet is not acceptable as roof material unless it
is covered with tiles or a false ceiling of heat resisting material is provided below or at
increased minimum heights as approved by the Chief Inspector of Factories.
3. Walls :
(i) What will be the material used for the construction of the walls ?
(ii) Will the walls be plastered smooth inside?
4. Floor :
(i) What will be the material used for flooring?
5. Windows and Skylights :
(Please fill in the attached statistical Form in respect of every work-room, office, godown etc)
Note :- (i) Sill height of windows at working level should bot exceed 1 (one) metre.
(ii) Please state whether all the windows are fully openable. If not, what is the percentage
of such windows are openable?
6. Doors :
(i) Is the minimum size of every door affording exit from work-room, office etc.
(195 centimetres x 90 centimetres)
(ii) Are all the doors affording exit from work-rooms, office etc (except those of the sliding
type) opening outwards or in the directions of the nearest exit ?
7. Emergency Exits :
(i) Are Fire exits provided in accordance with the provisions of Rule 70 (9).
8. Latrines and Urinals :
(i) Are these in accordance with the requirements of Section 19 read with rules 45 to 53?
(ii) (a) Is separate enclosed accommodation provided for males and females?
(b) Please state the number of Latrines provided for :
Existing Proposed Existing Proposed
(1) Males (2) Females
(c) Please state number of Urinals provided for Males :
Existing ………………………………. Proposed………………………….
(iii) Is the proposed accommodation approved by the Health Department?
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Note :- Latrines and urinals communicating with work-room, office etc. can not be accepted [ Vide
section 19 (1) (c) ] .
9. Wash Places :
(i) Are the proposed wash places in accordance with the requirements of section 42 read
with rule 4?
(ii) (a) Is separate enclosed accommodation provided for male and females ?
(b) Please state the number of proposed taps on stand pipes, wash basins and bath-
rooms for the use of males and females separately.
10. If your factory is situated in a common compound covered under section 93 of Factories Act,
1948, please fill in the Form attached to this Questionnaire
11. Cloak Room :
(i) Is cloak-room provided for workers ? if so, state the area.
(ii) Is separate cloak-room provided for female workers ? if so, state the area
(iii) Will lockers be provided for workers? Are the arrangements made for drying of wet
clothing? (Please see Rule 75).
12. Canteen:-
(Applicable to factories where more than two hundred and fifty workers are ordinarily employed.)
(i) Are the plans of the canteen submitted in duplicate to the Chief Inspector of Factories for
approval ?
(ii) Is proposed canteen in accordance with the requirements of section 46 read with rules 79 to
85?
(iii) Is the floor area of the dining hall calculated ate the rate of 1 sq. metre per dinner for 30 per
cent of the maximum number of workers working at any one time ?
(iv) Please state maximum number of workers working at any time and the floor area of the
dining hall in each section.
(1) Males :
(2) Females :
(v) Is separate enclosed accommodation provided in the dining hall for female workers ?
(vi) Are doors and windows of the Canteen made fly-proof?
(vii) Is the proposed Canteen situated at a distance of not less than 15 metres from latrines,
urinals, boiler house, coal stock, ash dumps or any other source of smoke or obnoxious
fumes ?
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13. Shelters, Rest Rooms and Lunch Rooms:
(Applicable to those factories wherein more than 150 workers are ordinarily employed.)
Note :- It should be noted that the provision of shelter and lunch room required under section 47 is
distinct from dinning hall of the Canteen required under section 46.
(i) Are the plans of the proposed work submitted in duplicate to the Chief Inspector of
Factories for approval ?
(ii) Is the proposed work in accordance with the requirements of section 47 read with rule
86 ?
(iii) Is the proposed shelter, rest room and lunch room conveniently situated for workers ?
(iv) What is the approximate number of workers likely to take advantage of this
accommodation ?
(v) Is the floor area of the proposed work sufficient to accommodate the workers at the
rate of 1 sq. metre per head ?
14. Creches
(Applicable to factories where in more than fifty women workers are ordinarily employed)
(i) Are the plans of the Creches submitted in duplicate to the Chief Inspector of Factories for
approval ?
(ii) Is the proposed Creche in accordance with the requirements of section 48 read with rules
87 to 91 ?
(iii) What is the approximate number of children to be accommodated in the Creche ?
(iv) Is the floor are of the Creche provided at the rate of 2 sq. metres per child ? Please state
the floor area.
(v) Are the following provided:-
(a) A wash for children and for washing their clothes.
(b) Sanitary accommodation for children
(c) A cupboard for storage of clothing, food etc.
(d) A room for the Nurse
(e) A suitable fenced and shady open air playground for older children
(f) Accommodation for storage of milk, food etc.
(g) Mother‟s feeding room.
15. Ambulance Room :
(Applicable to factories wherein more than five hundred workers are ordinarily employed.)
(i) Are the plans of the Ambulance room submitted in duplicate to the Chief Inspector of
Factories for approval ?
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(ii) Is the proposed Ambulance room in accordance with the requirements of section 45 (4)
read with rule 78 ?
(iii) Is the floor area of the Ambulance room minimum 24 sq. metres ?
(iv) Are the floor and the walls of proposed Ambulance room to be made of smooth, hard and
impervious materials ?
(v) Are the following provided :-
(a) Doctor‟s examination room.
(b) Sitting room for visitors
16. Layout of Machinery.
(i) Are aisles and passage ways in the factory clearly marked on the layout ?
(ii) Is a clear distance of 1 metre maintained between any machine and the nearest wall/column
and also in between machines ?
(iii) Does the layout provide a free passage way giving access to the means of escape in the case of
fire and emergency ?
Signature of the Applicant
Date :
Place :
Name and address of the Architect :
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A P P E N D I X
(To be filled in, in case the factory is or will be situated in a common compound under section 93
of the Factories Act. 1948)
(i) Name and Address of the owner of the compound :
(ii) Maximum number of workers working at a time in all the factories situated in the compound :
(a) Males:
(b) Female:
(iii) Number of latrines provided in the compound :
(a) Males :
(b) Female :
(iv) Number of urinals provided in the compound :
(a) Males :
(b) Female :
Note :- Separate enclosed accommodation shall be provided for female workers.
(v) Is no objection letter from the owner of the compound, allowing to start or extend a factory
for the purpose under reference obtained ? If so, please attach a copy.
Note :- It would be preferable, if in addition to supplying information under items (ii) to (v) above
you obtain a certificate to that effect from the owner of the compound and attach a copy
thereof here.
Signature of the Applicant
Date :
Place :
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D E C L A R A T I O N
1. From date , it is proposed to employ workers at
factory.
2. From , we started our production by employing ten or more than ten workers
and by using power.
3. From , we have started production at factory by employing 20 or more
workers, and without using electrical power.
4. I declare that the factory premises of which application is made was not rejected in
past by the Director, Industrial Safety and Health, Maharashtra State, Mumbai nor we
received any letter from the said Department. Also before this any officer is rejected
our application as per the Factory Act 1948.
5. Plans of the Factory Premises are approved / not approved by the Director, Industrial
Safety and Health, Maharashtra State, Mumbai vide in his letter no.
dated or submitted for approval on or will be
submitted within days.
Name of the Factory
Date :
Name of the Occupier
Place :
Signature of the Occupier
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The Maharashtra Factories Rules, 1963
FORM - 2 ( See rules 5 and 14 )
Application for Registration and Notice of Occupation specified in sections 6 and 7 ( To be submitted in TRIPLICATE )
1. Full name of factory with factory licence number, if
already registered.
2. Full postal address and situation of the factory
3. Full address to which communication relating to the
factory should be sent.
4. A flow chart of the manufacturing process :
a) Carried on the factory during the last twelve
months (in the case of factories in existence on
the date of commencement of the Act)
AND
b) To be carried on in the factory during the next
twelve months (in the case of the all factories)
AND
c) Supplemented by a brief description of the
process in its various stages, list of the raw
materials used, intermediate products including
emission of toxic gases, etc. finished products,
by-products, their quantities, method of storage
and handling, loading and transport and details of
the arrangements for the disposal of trade waste
and effluents the likely hazards and the methods
to control or eliminate them.
5. Name of manufactured. To be manufactured.
a) The principal product
b) Other product.
6. Nature and total amount of (H.P.) power installed.
7. Maximum number of workers proposed to be
employed on any one day during the year.
8. Maximum number of workers employed on any one
day during the last twelve months (in the case of
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factory in existence on the date of commencement
of that.)
9. Full name and residential address of the person who
shall be manager of the factory for the purpose of
the Act.
10. Full name and residential address of the occupier-
(i) The proprietor of the factory in case of private
firm / proprietary concern.
(ii) Directors in case of public limited liability
company / firm.
(iii) Where a managing agent has been appointed,
the name of the managing agent and director
thereof.
(iv) Shareholder in case of a private company.
(v) The Chief Administrative Head in case of a
Government factory or a factory runs by a local
authority or by any statutory corporation or
body.
11. In case of a factory constructed or extended after
the date of the commencement of these rules.
a) Reference number and date of approval of the
plans where for old or new building or for
construction or extension of factory by the State
Government / Chief Inspector.
b) Reference number and date of approval of the
arrangement, if any, made for the disposal of
trade waste and effluents and the name of the
authority.
12. Full name and address of the owner of the premises
of the building (including the precincts thereof
referred to in section 93.)
13. Amount of fee (Rupees ) paid
in treasury on vide challan No.
(enclosed)
14. Amount of fee (Rupees )
Cheque vide enclosed cross postal
order No. dated on
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Bank / Postal Office
drawn in favour of the Chief Inspector of Factories.
15. Amount of fee (Rupees ) paid
by bank adjustment vide order No. dated
(copy enclosed).
Signature of Occupier
Date
Signature of Manager
Date
Note:
1. This form should be completed in ink in block letters or typed.
2. Any subsequent change in any of the particulars given in columns 1 to 15 above
should be reported immediately.
3. In case of factory where number of provision to sub-section (1) and (2) of section 100
a person has been nominated as occupier, information required in the item No. 10
should be supplied only in respect of that person, and the form should be accompanied
by the nomination duly signed by the directors or the shareholders, as case may be.
4. Only one of the item No. 13 or 14 or 15 of the form should be filed as may be
applicable to the case, item No. 14 should be filled in case of factories in Greater
Mumbai and such factories outside Greater Mumbai as may prefer to pay the amount
by crossed postal order except Government factories. Item No. 15 should be filled in
the case of Government factories only and item No. 13 in all other cases.
5. Item No. 12 is to be filled only when more than one factory is situated in the same
premises or in building.
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FORM NO. 3 ( See Rules 5, 8 and 11 )
For the year
Application for * licence / Renewal of licence of a factory.
1. Full name the factory
2. Full postal address and situation of the factory
3. Full address to which communication should be
carried (where the factory address serves the
purpose of communication also, this information
need not be given)
3(A) A flow chart of the manufacturing process is
supplemented by a brief description of the process
in its various stages, list of the raw materials used,
intermediate products including emission of toxic
gases etc. finished products, by-products, their
quantities, methods of storages and handling
loading and transport and details of the
arrangement for the disposal of trade waste and
effluents control or eliminate them.
4. Maximum number of workers to be employed on
any one day during the year.
5. Installed H. P.
5(A) The period (not exceeding three years) for which
licence or renewal of licence is applied for
6. Name and residential address of Occupier
7. Name and residential address of manager
8. Amount fee (Rupees )
paid vide * treasury chalan / crossed cheque / postal
order on or by
book adjustment vide order No.
dated the .
9. Signature of Occupier
10. Signature of Manager
Date :
Place :
* Strike out whichever is not applicable.
Here affix
Court Fee
Stamp of
Rs.2.50
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MAHARASHTRA STATE ELECTRICITY BOARD
FORM No. A-1
To,
The Maharashtra State Electricity Board,
(Office)
1. I/We here request you to supply electrical energy to
the premises owned/occupied by me/us hereinafter
described.
2. I/We hereby agree to keep supply and pay for the
side energy security as may be demand in
accordance with the rates and conditions of supply
of the board in force from time to time and further
declare and agree to take supply energy for the
under mentioned purpose for my/our benefide use
for a period of not less than two years from the date
of commencement of supply.
3. I/We also undertake to supply within three months
from the date the board intimates that it is the ready
to supply to our premises failing which I/We
undertake to pay the board the minimum charges as
may be applicable.
4. In the event of death of individual/desolutions of
amalgamation of the company I/We hereby
nominate Shri/Smt./Sau
to receive or adjust the deposit
outstanding in/our name.
5. This requisition is for :
a) A new service, b) Re-connection, c) An alteration
to may existing installation, d) A temporary service,
e) A change of name Shri. .
6. Description of premises
House No. Land Survey No.
Street
District : Town/Village
Owner‟s Name :
Owner‟s Address :
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Incandescent Lamps Fans Plugs Heater etc. Motors Total
Demand
No. Wattage of
each
No. Wattage of
each
No. Wattage of
each
No. BHP of
each
KW/HP
7. My/Our requirement are as follows :
The wiring will be charged out by :
Name of the licenced wiring contractor :
His Licence No. :
His Address :
Date : (Signature of the applicant)
Name of applicant : .
Occupation : .
Address : .
.
(Strike out Items not applicable)
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Application for Consent / Authorisation
Date :
Form
To,
The
Maharashtra Pollution Control Board,
Sir,
I/We hereby apply for *
1. Consent to Establish/Operate/Renewal of consent under section 25 and 26 of the
Water (Prevention & Control of Pollution) Act, 1974, as amended.
2. Consent to Establish / Operate / Renewal of consent under section 21 of the Air
(Prevention & Control of Pollution) Act, 1981, as amended.
3. Authorization / renewal of authorization under rule 5 of the Hazardous wastes
(Management and handling) Rules , 1989,as amended in January,2000, in connection
with my / our /existing/ proposed/ altered /additional manufacturing /processing
activity from the premises as per the detail given below
Part A: General
1. Details of the planning permission obtained from
the local body/Town and Country Planning
authority / Metropolitan Development authority /
designated authority.
Name of the local body under whose jurisdiction the
unit is located and name of the license issuing
authority.
2. (a) Are you registered industrial unit ?
(b) If yes, give the number and date of registration.
3. Gross capital investment of the unit without
depreciation till the date of application (Cost of
building, Land, Plant and Machinery). [To be
supported by an affidavit / undertaking on Rs. 20/-
stamp paper, annual report or certificate from a
Chartered Accountant for proposed unit(s), give
estimated figure].
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4. If the site is located near sea-shore / river bank /
other water bodies / Highway, Indicate the crow fly
distance and the name of the water body, if any.
5. Does the location satisfy the Requirement Under
relevant Central / State Government Notification
such as Coastal Regulation Zone? Notification on
Ecologically Fragile Area, Industrial Location
Policy, etc. If so, give details.
6. If the site is situated in notified industrial estate
(a) Whether effluent collection, treatment and
disposal system has been provided by the
authority.
(b) Will the applicant utilize the system if
provided?
(c) If not provided, details of proposed
arrangement.
7. (a) Total plot area
(b) Built-up area.
(c) Area available for the use of treated sewage /
trade effluent for gardening / irrigation.
8. Month and year of commissioning of the unit.
9. Number of workers and office staff
Workers Staff Hrs. of shift Weekly off
10. (a) Do you have a residential colony within the
premises in respect of which the present
application is made?
(b) If yes, please state population staying.
(c) Indicate its location and distance with reference
to plant site.
11. List of products and bi-products manufactured in
tones/month, Kl/month or numbers/month with their
types i.e. Dyes, Drugs etc. (Give figures
corresponding to maximum installed production
capacity).
12. List of raw materials and process chemicals with
annual consumption corresponding to above stated
production figures, in tones/month, Kl/month or
numbers/month.
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13. Description of process of manufacture for each of
the products showing input, output, quality and
quantity of solid, liquid and gases wastes, if any
from each unit process. (To be supported by flow
sheet and / or material balance and water balance
sheet).
Part B: Waste Water aspects
14. Water consumption for different uses (m3/day)
(i) Industrial cooling, spraying in mine Pits or
boiler feed, pollution of hydro generation sets.
(ii) Domestic purpose.
(iii) Processing whereby water gets polluted and the
pollution are easily Bio-degradable.
(iv) Processing whereby water bets polluted and the
pollutants are not easily Bio-degradable and are
toxic.
(v) Other such as agriculture, gardening, etc.
(specify).
15. Source of water supply, Name of the authority
granting permission if applicable and quantity
permitted.
16. Quantity of waste water (effluent) generated
(m3/day)
(i) Domestic : (v) Boiler Blowdown :
(ii) Industrial : (vi) Cooling water blowdown :
(iii) Process : (vii) DM Plants / Softening :
(iv) Washing : (viii) Tail race discharge from :
17. Water budget calculation accounting for difference
between water consumption and effluent generated.
18. Present treatment of sewage / canteen effluent (Give
sizes / capacities of treatment units)
19. Present treatment of trade effluent (Give sizes /
capacities of treatment units) [A schematic diagram
of the treatment scheme with inlet / outlet
characteristics of each unit operation / process is to
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be provided. Include details of residue Management
system (ETP sludges)].
20. (i) Are sewage and trade effluents mixed together?
(ii) If yes, state at which stage – Whether before,
intermittently or after treatment.
21. Capacity of treated effluent sump, Guard Pond if
any.
22. Mode of disposal of treated effluent with respective
quantity, m3/day
(i) Into stream / river (name of river)
(ii) Into creek / estuary (name of creek / estuary)
(iii) Into sea
(iv) Into drain / sewer (owner of sewer)
(v) On land for irrigation on owned land / lease
land.
Specify cropped area (To be supported by
relevant documents)
(vi) Quantity of treated effluent re-used / re-cycled
m3/day. Provided a location map of disposal
arrangement indicating the outlet(s) for
sampling.
23. (a) Quality of untreated / treated effluents (Specify
pH and concentration of SS, BOD, COD and
specific pollutants relevant to the industry. TDS
to be reported for disposal on land or into steam
/ river.
(b) Enclose a copy of the latest report of analysis
from the laboratory approved by State Board /
Committee / Central Board / Central
Government in the Ministry of Environment
expected characteristics of the untreated /
treated effluents.
Part C: Air emission aspects
24. Fuel consumption
Coal LSHS Furnace Natural Other
Oil Gas Specify
a) Fuel consumption (TPD/KLD) :
b) Calorific value :
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c) Ash content % :
d) Sulphur content % :
e) Other (specify) :
25. (A) Details of stack
(Process & fuel stacks: D.G. Set)
(a) Stack numbers(s) 1 2 3 4
(b) Attached to
(c) Capacity
(d) Fuel type
(e) Fuel quantity (Kg/hr.)
(f) Material of construction
(g) Shape (round/rectangular)
(h) Height m (above ground level)
(i) Diameter/ size in meters
(j) Gas quantity, Nm3/hr.
(k) Gas temperature 0C
(l) Exit gas velocity, mt/sec
(m) Control equipment preceding the stack
(n) Nature of pollutants likely to present in the
stack gases such as C12, Nox, Sox, TPm
etc.
(o) Emissions control system provided
(p) In case of D.G. Set generation capacity in
KVA (Attach specification including
residue management systems of each of
the control equipment indicating inlet /
outlet concentration of relevant pollutants)
(B) Whether any release of odoriferous compounds
such as Mercaptans, Phorate etc. Are coming
out from any storages or process house.
26. Do you have adequate facility for collection of
samples of emissions in the form of port holes,
platforms, ladder etc? As per Central Board
Publication “Emission regulation Part-III”
(December, 1985).
27. Quality of treated fuel gas emissions and process
emissions. Quantity of treated fuel gas emissions
and process emissions.
28. (Specify concentration of criteria pollutants and
industry / process-specify pollutants stack wise.
Enclose a copy of the latest report of analysis from
the laboratory approved by State Board/ Central
Board / Central Government in the Ministry of
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Environment & Forests. For proposed unit furnish
expected characteristics of the emissions.
Part D: Hazardous Waste aspect.
29. Information about Hazardous Waste Management
as defined in Hazardous Waste (Management and
Handling) Rules, 1989 as amended January 2000.
Type / Category of Waste as per
Schedule-I Schedule-II Qty. Method of
Cat. No. Type Class Type Kg/day Collection
Reception
Storage
Transport
Treatment
Disposal
30. Details about use of Hazardous of Waste
(i) Name of the Hazardous Waste / Spent chemical :
(ii) Quantity used / month. :
(iii) Partly from whom purchased :
(iv) Party to whom sold :
31. (a) Details about technical capability and
equipments available with the applicant to handle
the Hazardous Waste.
(b) Characteristics of Hazardous Waste(s). Specify
concentration of relevant pollutants. Enclose a
copy of the latest report of analysis from the
laboratory approved by State Board / Central
Board / Central Govt. in the Ministry of
Environment and Forest. For proposed units
furnish expected characteristics.
32. Copy of format of manifest / record keeping
practiced by the applicant.
33. Details of self-monitoring (source and environment
system).
34. Are you using any imported Hazardous Waste? If
yes, give detail.
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35. Copy of actual user Registration / Certificate
obtained from Ministry of Environment and Forest,
Govt. of India for use of Hazardous Waste.
36. Present treatment of Hazardous Waste, if any (give
type and capacity of treatment units).
37. Quantity of Hazardous Wastes disposal
(i) Within factory.
(ii) Outside the factory (specify location and
enclosed copies of agreement)
(iii) Through sale (enclosed documentary proof and
copies of agreement)
(iv) Outside State / Union Territory, if yes,
particulars of (1 and 3) above.
(v) Other (specify).
Part E: Additional information.
38. (a) Do you have any proposals to upgrade the
present system for treatment and disposal of
effluents / emissions and / or hazardous waste?
(b) If yes, give the details with time – schedule for
the implementation and approximate
expenditure to be incurred on it.
39. Capital and recurring (O&M) expenditure and
various aspect of environment protection such as
effluent, emission, hazardous waste, solid waste,
tree plantation, monitoring, data acquisition etc.
(give figures separately for items implemented / to
be implemented.
40. To which of the pollution control equipment,
separate meters for recording consumption of
electric energy are installed?
41. Which of the pollution control items are connected
D.G. set (captive power source) to ensure their
running in the event of normal power failure?
42. Nature, quantity and method of disposal of non-
hazardous solid waste generated separately from the
process of manufacture and waste treatment. (Give
details of area / capacity available in the applicants
land).
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43. Hazardous Chemicals – Give details of Chemicals
and quantity handled and stored
(i) Is the unit a Major Accident Hazard unit as per
Mfg. Storage Import Hazardous Chemicals
Rules?
(ii) Is the unit an isolate storage as defined under the
MSIHC Rules?
(iii) Indicate status of complains of rules 5, 7, 10,
11, 12, 13 and 18 of the MSIHC Rules?
(iv) Has approval of site been obtained from the
concerned authority?
(v) Has the unit prepared am off-site Emergency
Plan? Is it updated?
(vi) Has information on imports of chemicals been
provided to the concerned authority?
(vii) Does the unit possess a policy under the PLI
Act?
44. Brief details of tree plantation / green belt
development with applicant‟s premises (in hectors)
45. Information of scheme for waste Minimization,
resource recovery and recycling – implemented and
to be implemented separately.
46. (a) The applicant shall indicate whether industry
comes under Public Hearing. If so, the relevant
documents such as EIA, EMP, Risk Analysis etc.
shall be submitted, if so, the relevant documents
enclosed shall be indicated accordingly,
(b) Any other additional information that the
applicant desires to give.
(c) Whether Environmental Statement submitted?
If submitted, give date of submission.
47. I / We further declare that the information furnished above is correct to the best my /
our knowledge.
48. I / We hereby submit that in case of any change what is stated in the application in
respect of raw materials, products, process of manufacture and treatment and / or
disposal of effluent, emissions, hazardous waste etc. in quality and quantity, a fresh
application for Consent / Authorization shall be made and until the grant of fresh
Consent / Authorization no change shall be made.
49. I / We undertake to furnish any other information within one month of its being called
by the Board.
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50. I / We enclosed herewith a demand draft of Rs. drawn in
favour of Maharashtra Pollution Control Board as the fee for Consent / Authorization
for a period upto .
Yours faithfully,
Signature :
Name :
Designation :
Accompaniments :
1. Index / Site Plan showing the surrounding such as village, town, river, sea shore,
Transport Routes etc.
2. Detailed layout plan of the factory premises showing structures, water supply line,
storm drain, sewers for domestic effluents, for trade effluents, location of effluent
treatment and its disposal and any other useful information, drawing, tables etc.
3. Manufacturing process of each product with flow diagram and material balance.
4. Latest Joint Vigilance sample analysis report.
5. Details of air pollution control devices provided or proposed to be provided.
6. Ambient air quality report, if available.
7. Small Scale Industry‟s Certificate / No Objection Certificate from Directorate of
Industries, Govt. of Maharashtra / D.G.T.D. Licence.
8. Xerox copy of consent granted under Air & Water (P.& C.P.) Acts.
9. TLV of raw material.
10. Gross block investment certificate from C.A. / audited balance sheet.
11. Process flow sheet.
12. Chemical reactions involved in each process.
13. NOC from local body for proposed industry.
14. Water budget calculations.
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APPLICATION FOR ENVIRONMENTAL CLEARANCE
ANNEXURE – D
APPLICATION FROM
GENERAL INFORMATION
1.1) Does the proposal related to New project / expansion /
renovation / modernization / others. (Give details)
1.2) Plant capacity
Name of project
Installed capacity
Expansion capacity
1.3) Total cost of the proposed project
1.4) Pollution abatment cost such as control equipment /
Pollution Monitoring / Green belt Development
2. DETAILS OF THE SITE
2.1) Does the site fall under notified industrial area (i.e.
Maharashtra Industrial Development Corporation,
Private / Co-operative Industrial Estate). If not,
details thereof.
2.2) Whether the proposed site falls within 500 mt. of
the high tide line and low tide line. If yes, distance
from high tide line.
2.3) Whether the proposed site falls in the Balkumb
Kolshet area (Thane District) / Murud Janjira
(Raigad District) / Dahanu Tq. (Thane District). If
yes, details of location.
2.4) Whether the proposed site is within a distance of 25
KM from National Park / Sanctuary / Biosphere
Reserve / Monuments / Heritage site / Reserve
Forests. If yes, details thereof.
2.5) Present use of the land i.e. Agriculture / Grazing /
Forest / Mangrove / Marshy / Industrial / Others.
2.6) TOTAL LAND REQUIRED
a) Plant
b) Storage
c) Future expansion
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d) Area covered under Green belt development
plan. Layout plan showing green belt. Details
of afforestation programme. ( Please enclosed)
2.7) Types of natural system and distance from the site
such as Forest / Grass land / Mangroves / Water
body / Water shed.
2.8) Human settlement distance from the site – Kind of
settlement.
3. WATER
3.1) Consent under Water Act
a) Whether obtained
b) Conditions imposed, if any. How these are
proposed to be complied
3.2) Water requirement
m3/per day.
3.3) Source of Water Supply (ground water Canal,
River, Public supply system etc.)
3.4) Water balance at site.
3.5) Lean season water availability.
WASTE WATER DETAILS
3.6) Total – daily discharge
1) Cooling
2) Processing
3) Domestic
4) Any other
3.7) Details of percentage of Recycling envisaged.
3.8) Details of effluent treatment method.
3.9) Effluent disposal by Open channel / Pipe line /
Covered drain / Others.
3.10) Final point of discharge (Land / Nallah / Stream /
Sewer / River / Estuary / Sea)
Distance from the plant.
3.11) If to be used for gardening / afforestation, give
land development details.
4. ATMOSPHERIC EMISSION
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4.1) Maharashtra Pollution Control Board Consent under
Air Act, 1981.
4.2) Climatic conditions at the site (i.e. Arid, Semi-Arid
etc.)
4.3) Maximum / Minimum / Mean Annual Temperature
/ Rainfall.
4.4) Frequency Inversion in different seasons.
4.5) Thermal heat.
a) Source
b) Method of abatment
4.6) Odour
a) Source
b) Method of abatment
4.7) Nature and concentration of Emission of SPM, gas
(Carbon Monoxide, Carbon Dioxide, NOx, CHn,
etc.) from the project.
4.8) Control measures proposed to mitigate the air
emission such as stack, Dust Collector etc.
4.9) Whether the control measures proposed will be
sufficient to control the air pollution.
5. SOLID / HAZARDOUS WASTES / TOXIC WASTE
5.1) Quality of Solid / Hazardous / Toxic Wastes
generated per months.
5.2) Nature of Solid / Hazardous / Toxic Waste.
5.3) Disposal method of Solid / Hazardous / Toxic
Wastes such as land fill, Incinerator.
5.4) Recovery / Recycling / Possibilities.
5.5) Possible user of Solid Waste.
5.6) a) Does the Toxic / Hazardous Waste attract
Hazardous Waste (Management Handling) Rules
1989. If yes, whether Authorization from
Maharashtra Pollution Control Board obtained.
b) Conditions in the Authorization. Indicate how
they are to be compiled with.
5.7) Method of disposal of Solid Waste.
a) Anticipated Environment problems.
b) Proposed mitigation measures.
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6. NOISE VIBRATION
6.1) Ambient Noise level
6.2) Source of Noise vibration during the operation of
the plant.
6.3) Noise and vibration control measures proposed.
6.4) Are the proposed control measures sufficient to
mitigate the Noise and vibration level.
7. ENERGY REQUIREMENT
7.1) Total power requirement
a) Existing
b) Proposed
7.2) Source of supply
7.3) Complete Environmental details to be furnished
separately if captive power unit is proposed.
8. PROCESS DETAILS
8.1) Detail Manufacturing process / flow chart and
technology transfer, if adopted.
8.2) Plant and Machinery and in-built anti-pollution
equipment.
RAW MATERIAL
8.3) List of Raw Materials used in process with quantity
tones per month (which attracts Hazardous
Chemicals Rules, 1989).
8.4) Precautionary measures adopted in transportation
and handling of / Explosive Material.
8.5) Provide layout plan of the plant or part or both
indicating area(s) where Hazardous / Hazardous /
Toxic / Flammable / Explosive Material(s) will be
stored.
8.6) Indicate safety distance and capacity of each
storage.
8.7) Storage facilities for Hazardous / Toxic /
Flammable / Explosive Material and safety
provision.
8.8) PRODUCTION
Main product MT/PM.
By-product MT/PM
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Intermediate product MT/PM
8.9) Are the proposed products banned abroad for
manufacturing.
8.10) Precautionary measures adopted in case of
Hazardous / Toxic / Flammable products.
8.11) The Quality of Hazardous substance to be stored,
the location of the tank area from Road /
Residential Area / Near Industries.
8.12) Risk assessment Report and Disaster Management
plan for the project in case Hazardous substance is
to be handled.
9. a) Environmental Impact Assessment
b) Environment Management Plan
10. Details of Environmental Management Cell.
I hereby give an undertaking that the data and information given above are true to the
best of my knowledge and belief and I am aware that if any part of the data / information
submitted is found to be false or misleading at any stage, the project be rejected and the
clearance given, if any, to the project is likely to be revoked at our risk and cost.
Signature of the applicant
with name and full address.
Date:
Place:
Given under the seal of organization on
behalf of whom the applicant is signing.
In respect to item for which data are not required or is not available as per the
declaration of project proponent, the project would be considered on that basis.
Report – prepared as per guidelines
of MOEF issued from time to time.
However, this may not be necessary
in case of projects covered in
Annexure “B” upto investment of
Rs. 20 crores and in Annexure “C”
if the investment is upto Rs. 10
Crores.