Karnatakastate Pollution Control Board

KARNATAKASTATE POLLUTION CONTROL BOARD

FORM-I

(To be submitted in Duplicate)

Application for consent for discharge of emission/continuation of discharge of emission under Section.21 of the Air (Prevention & Control of Pollution) Act, 1981

(See Rule.20)

From:

To:

The Member Secretary

KarnatakaState Pollution Control Board

No. 49, Parisara Bhavan

Church street

Bangalore

Through: Environmental Officer, ______

I/We here by apply for the Consent for operation of the industry for the period ______to ______under Section 21 of Air (Prevention & Control of Pollution) Act 1974 to make emissions from the industrial plant owned by ______. The relevant information is given below.

1. / Name & address of the Applicant ( Occupier’s name, designation and correspondence address
STD code Phone No.
Fax No.
E-mail address
2. (a) / Name & address of the Industry (Location of the Industry)
Survey No/Plot No.
STD code Phone No.
Fax No.
E-mail address
2(b) / Whether the plant area is declared as Prohibited area: if yes state the name of the authority and furnish the copy of the order which the area has been declared as prohibited area.
2.1 / Indicate the present use of the land in the vicinity of (10 km radius) the site.
Human settlement more than 1000 population( specify the name of village/population and distance from the plant)
Sanctuary- National Park-Hills- Mountains- Mangroves, backwaters of Reservoir etc., ( mention the distance from the site)
Ancient monuments( mention the distance and direction from the plant)
2.2(a) / Total land area
Buildup area
Vacant land
Greenbelt area
2.3 / Name and designation of the person incharge of pollution Control in the industry.
3 / Size of the industry
4 / Date of commissioning
5 / No. of employees( The total nos. including office staff and contract labour and labour on roll shall be furnished)
6 / Products manufactured (Total list of products/Byproducts with the production capacity (licenced and installed)/month shall be furnished).
(a) Installed capacity
(b) Consented capacity
(c)Any diversification / expansion ( give details)
7 / List of raw materials used per month( tones/month)
Present raw materials used
Proposed raw material used
8 / Brief manufacturing process( please attach flowchart, water and material balance statement)
(a) Flow chart
(b) Water and material balance statement & chart

9. (a) The air pollution sources are shown below:

Stack no / Source of air pollution / Type of fuel / Sulphur content / Consumption / Chimney height & air pollution control system provided/proposed / Chimney height and air pollution control system required as per previous consnsent
Kgs/hr in case of liquid fuel / T/hr in case of agro based fuel
9(b) / Detailed technical specification of air pollution control equipment, final flue gas emission rate, temperature, concentration of air pollutants shall be furnished in case of new plant alongwith schematic flowchart showing the source of air pollution and the pollution control equipments in section shall be furnished.
9(c) / Details of solid/liquid waste generated during the process of air pollution control/
Solid
(1) Bottom ash
(2)Fly ash
(3) other solid waste/by product
Type of handling and disposal
(1) write up
(2) Schematic diagram
(3) Future use
Liquid
(1) Quantity
(2) Characteristics
(3) Mode of storage and handling.

10. Analysis report of each air pollution source ( mg/Nm3)

Stack attached to / Gas quantity / Temp / Exit gas velocity / Analysis of flue gas process/emission
SO2 / SPM / CO2 / CO / NOx / HC / Other

11. Ambient air quality data:

11(a) / For new industry, background emission data and GLC’s after installation of proposed industry shall be furnished
11(b) / The existing industry shall furnish the statistical interpretation of AAQ data collected during the previous consent period along with graphical representation
12 / Whether the air pollution control systems are completely put up and are in operation.
13 / Whetherthe air pollution control systems are letting the emissions within the standards stipulated by the Board
14 / Date, Month and year by which the air pollution control system will be completely put up
15 / Noise pollution
Source
Noise control measures
Noise level at plant boundary
16 / Whether the environmental management system followed by the industry/local authority/layout/township( attach details)
17 / Whether covered under the PLI Act, if so furnished a policy No, Expiry date and the insurance amount.
18(a) / Total grass capital investment of the unit in Rupees (this shall be inclusive of land, building, Plant and machinery and other movable and immovable assets in the name of the industry without depreciation. Please enclose copy of the extract from the Balance Sheet with latest fixed investment schedule.
18(b) / The estimated expenditure/ incurred for implementation of air pollution control measures
18© / Estimate cost for upgradation of air pollution control measures, give all the details and the proposed date of completion of this work
18(d) / Annual operation and maintenance cost of air pollution control measures

19. Consent fee details.

DD.No.______Dated ______for Rs.______in favour of ‘Karnataka State Pollution Control Board’ ,as fees payable under Section 21 of the Act & Rule 20 of the Air Rules.

20.I/We further declare that the above furnished information is true & correct to the best of my/our knowledge. I am aware that the any wrong information furnished, is punishable under Air Act.

21.I/We hereby submit that, in case of charge either of the point of discharge or the quantity of discharge or its quality fresh application for consent shall be made & until such consent is granted no change shall be made.

22.I/We hereby agree to submit to the State Board any application for renewal of consent four months in advance date of expiry of the consent for outlet/discharge if to be continued thereafter.

23.I/We undertake to furnish any other information within one month of its being called by the State Board.

Yours faithfully

(Name and signature of the Occupier)

INSTRUCTIONS FOR FILLING UP & SUBMITTED THE APPLICATION

Do not leave any columns blank. Write N.A.for whichever is not applicable. Incomplete application will not be processed and will be considered as incomplete

Submit the application for renewal atleast 120 days in advance prior to the expiry date.

Submit the application in duplicate along with the following documents to the Divisional Office/Regional Office concerned of the Board while retaining one copy with you for your reference. Applications pertaining to Bangalore Regional Offices shall be submitted at Helpdesk, Karnataka State Pollution Control Board, No.49, ParisaraBhavana, Church Street, Bangalore-01.

(a)SSI Certificate if applicable

(b)Latest audited balance sheet (fixed assets schedule).

(c)Manufacturing process flow-chart

(d)Compliance to the previous consent conditions if any.

(e)Latest analysis report of the effluents/stack emission report.

(f)Panchayat license or any other licenses obtained incase of consent for establishment.

(g)Land conversion certificate in case of consent for establishment.

(h)Required consent fee in the form of D.D. in favour of Karnataka State Pollution Control Board as per Annexure I enclosed on the fixed assets of the industry including land, building plant & machinery & any other movable or immovable assets in the name of the factory as per the gross block value of the fixed assets schedule of the balance sheet.

Annexure-I

CONSENT FEE STRUCTURE

(with effect from 2-4-1998 under Air Act and 20-04-1998 under Water Act)

Sl no / Capital investment by industries / Consent fee in rupees for different categories of industries
RED / ORANGE / GREEN
(a) / Exceeding Rupees 1000 crores / 2,00,000 / 1,75,000 / 1,50,000
(b) / Exceeding Rupees 500 crores but not exceeding Rupees 1000 crores / 1,50,000 / 1,25,000 / 1,00,000
(c) / Exceeding Rupees 250 crores but not exceeding Rupees 500 crores / 1,00,000 / 90,000 / 75,000
(d) / Exceeding Rupees 50 crores but not exceeding Rupees 250 crores / 75,000 / 60,000 / 50,000
(e) / Exceeding Rupees 25 crores but not exceeding Rupees 50 crores / 50,000 / 40,000 / 30,000
(f) / Exceeding Rupees 10 crores but not exceeding Rupees 25 crores / 30,000 / 25,000 / 20,000
(g) / Exceeding Rupees 5 crores but not exceeding Rupees 10 crores / 20,000 / 17,500 / 15,000
(h) / Exceeding Rupees 1 crore but not exceeding Rupees 5 crores / 15,000 / 12,500 / 10,000
(i) / Exceeding Rupees 50 lakhs but not exceeding Rupees 1 crore / 6,000 / 5,000 / 4,000
(j) / Exceeding Rupees 25 lakhs but not exceeding Rupees 50 lakhs / 3,000 / 2,500 / 2,000
(k) / Exceeding Rupees 10 lakhs but not exceeding Rupees 25 lakhs / 2,000 / 1,750 / 1,500
(l) / Exceeding Rupees 5 lakhs but not exceeding Rupees 10 lakhs / 1,500 / 1,250 / 1,000
(m) / Exceeding Rupees 1 lakhs but not exceeding Rupees 5 lakhs / 500 / 250 / 200
(n) / Rupees 1 lakh and below / 200 / 150 / 100