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Form 4: (See Rules 5 (6) and 22 (2) )

This document is an annual return form that must be submitted by the occupier or operator of a hazardous waste disposal facility to the relevant pollution control authority. [1] It requests information such as the name and address of the facility operator, [2] types and quantities of hazardous wastes generated, and descriptions of storage, treatment, transportation and final disposal of wastes. [3] The form is used to track and regulate the management of hazardous wastes from generation to final disposal.

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Vinod Chaudhari
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566 views1 page

Form 4: (See Rules 5 (6) and 22 (2) )

This document is an annual return form that must be submitted by the occupier or operator of a hazardous waste disposal facility to the relevant pollution control authority. [1] It requests information such as the name and address of the facility operator, [2] types and quantities of hazardous wastes generated, and descriptions of storage, treatment, transportation and final disposal of wastes. [3] The form is used to track and regulate the management of hazardous wastes from generation to final disposal.

Uploaded by

Vinod Chaudhari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as RTF, PDF, TXT or read online on Scribd
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FORM 4 

[See rules 5(6) and 22 (2)] 
FORM FOR FILLING ANNUAL RETURNS BY THE
OCCUPIER OR OPERATOR OF FACILITY 

[To be submitted by the occupier/operator of disposal facility to State Pollution Control Board/ 
th 
Pollution Control Committee by 30 June of every year for the preceding period April to March] 

1 : Mahima Pure Spun
.  Name and address of the    (A Unit of Mahima Fibre Pvt Ltd.)
generator/operator of facility  Plat no.73­74 Pithampur  Sector­2 Dist.Dhar,
(M.P)  
2 Name of the authorized person : B.S.Yadav ­ Factory Manager
.  and full address with    Plat no.73­74  Pithampur Sector­2 Dist­
telephone and fax number.  Dhar,(M.P.)
3 Description of hazardous  : Chemical form 
Physical form with description 
.  waste   
Inliquid foam Spent oil
Category 5.1 

4 :
Quantity of hazardous wastes  Type of hazardous waste  Quantity (in Tonnes/KL) 
.   
(in MTA)  (a) 
(b) 
(c) 
………………………  …………………………….. 
5 Description of Storage  :
.   
6 Description of Treatment  :
.   
7 Details of transportation  : Name &  Mode of packing  Mode of  Date of 
.    address of transportatio transportation 
consignee  n 

8 Details of disposal of  : Name &  Mode of packing  Mode of  Date of 


.  hazardous waste    address of transportatio transportation 

* delete whichever is not applicable # enclose list of other agencies 
: : 

Date:………………………  Signature Designation 
Place…………………………

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