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Hazardous Materials (Management, Handling and Transboundary ...

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FORM − 10[see rule 21]Form for Filing Returns <strong>and</strong> Records by Occupier/Operator of Facility[To be submitted by occupier/operator of disposal facility to State PollutionControl Board/ Committee by30 th June of every year for the preceding period Aprilto March]1. Name <strong>and</strong> address of thegenerator/ operator of facility2. Name of the authorised person<strong>and</strong> full address with telephone<strong>and</strong> fax number3. Description of hazardousmaterials/waste4. Quantity hazardous materials/wastes (in MTA )5. Description of Storage6. Description of TreatmentPhysical form withdescription7. Details of transportation Name &address ofconsignee8. Details of disposal of hazardouswaste9. Environmental surveillance Data(Date of measurement)9. Quantity of recyclable materialssent back to the manufacturers*<strong>and</strong> others #* delete whichever is not applicable# enclose list of other agenciesName &address ofOperatorGroundwateranalysis(ii)Mode OfpackingDisposalSiteSoilAnalysisChemical formMode oftransportationDisposalMethodAiranalysisDate oftransportationDate ofdisposalOtheranalysisPlace : ….......................Date : …........................Signature:Designation:57

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