FORM 4: FORMAT FOR SUBMISSION OF RETURNS REGARDING DISPOSAL OF HAZARDOUS WASTE
[Rule 9(2)]
(To be submitted to the 2[State Pollution Control Board or Committee])
1. Name and address of the institution
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2. Details of waste disposal operation:
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Sl. No. |
Date of issuance of authorization for the disposal of hazardous waste and its reference number |
Description of hazardous waste |
Mode of transportation to the site of disposal |
Site of disposal (Attach a sketch showing the location (s) of disposal |
Brief description of the method of disposal ) |
Date of disposal |
Remarks (if any) |
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Physical form and contents |
Chemical form |
Total volume of the hazardous waste disposed of with No. of packages |
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3. Details of environmental surveillance:
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Date of measurement |
Analysis of ground water |
Analysis of soil samples |
Analysis of air sampling |
Analysis of any other samples (give details) |
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Location of sampling |
Depth of sampling |
Date |
Location of sampling |
Depth of sampling |
Date |
Location of sampling |
Date |
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Name and signature of the head of the facility
