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Form 4 – Hazardous Wastes (Management and Handling) Rules, 1989

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

………………………………………………………………………………………………….

2. Details of waste disposal operation:

……………………………………………………………………………………………………..

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)

Physical form and contents

Chemical form

Total volume of the hazardous waste disposed of with No. of packages

 

 

 

 

 

 

 

 

 

 

3. Details of environmental surveillance:

Date of measurement

Analysis of ground water

Analysis of soil samples

Analysis of air sampling

Analysis of any other samples (give details)

Location of sampling

Depth of sampling

Date

Location of sampling

Depth of sampling

Date

Location of sampling

Date

 

 

 

 

 

 

 

 

 

 

Name and signature of the head of the facility 

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