Form IVA/IA

KERALA STATE POLLUTION CONTROL BOARD

APPLICATION FOR CONSENT/AUTHORISATION/REGISTRATION

(INDUSTRIES/ESTABLISHMENTS)

PART I

NAME AND ADDRESS OF INDUSTRY/ESTABLISHMENT:

PAS ELECTRICALS
VENGACHUVADU
VAZHAKKULAM P O
MANJALLOOR
PIN - 686670

I am the occupier of above industry/establishment. I hereby apply for clearance/s under : tick
appropriate cells

NAME OF STATUTE ESTABLISH OPERATE RENEW/AUTORENEW

* The entries in the application/s are true to the best of my knowledge,information and belief.
I have signed hereunder,at the end of the application and on enclosure in affirmation of that.

* I undertake to furnish any information, explanation and/or clarification within 15 days of it

being called for to make my application complete. I undertstand that the date on which the
application is made complete in all respect will only be counted as the date of the application.

* I agree to abide by the conditions of the Consent/Authorisation/Registration and the

pertinent legal provisions.

* I undertake to render access to functionaries and empowered officers of the Board to inspect
the industry/establishment and its premises and peruse records thereof.

* Any change in line of activity/pollution load will be effected only after obtaining the
Consent/ Authorisation/Registration for which a fresh application will be made.

Signature :
Place :ERNAKULAM II Name :SHYLAJA M P
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Date : 04/08/2021 Designation : proprietor

PART II
GENERAL INFORMATION

1.

REGISTERED OFFICE OCCUPIER

ADMINISTRATIVE OFFICE
Postal Address VENGACHUVADU SHYLAJA M P
VAZHAKKULAM P O PUTHEDATH HOUSE
MANJALLOOR VAZHAKKULAM P O
PIN - 686670 MUVATTUPUZHA
PIN - 686670

PIN 686670 686670

Telephone 91-9895486422 -

Fax - -

e-mail [email protected] [email protected]

Website - -

2.

OWNERSHIP AREA IN ADDRESS OF

SQUARE METRE LESSOR,
IF ON LEASE

Built up area - 116.90

Total area - 769 -

Survey No. 503/2-1 Ward NO.& 3
Name
Village MANJALLOOR Panchayat/ VAZHAKKULAM
Municipality/
Corporation

Taluk MUVATTUPUZHA District ERNAKULAM II

(Possession certificate from Taluk Office in support of ownership of land shall be furnished
in case of application for stone crushers)

3.

Management Individual
 Scale Small
Category GREEN

4. Particulars of last clearance/s obtained :

CLEARANCE GRANT/
REFUSAL,No.,Date,Validity

Consent Under Water Act NA

Consent Under Air Act NA

ICE/ICO/ICO(R) NA

Authorisation under BMW Rules NA

Registration under HW Rules NA

5. Date of Commissioning: Jan/2021

(if new,anticipated date)

6. Nearest building/water body within 100m:

OWNERSHIP , USE ,DISTANCE, in m

(to be marked on site
plan)

From The Building AS PER THE SITE PLAN

From Effluent Treatment Plant AS PER THE SITE PLAN

 Dug well/tube/pond AS PER THE SITE PLAN

Stream/rever/lake/backwater/sea AS PER THE SITE PLAN

7. Raw materials(including fuels & lubricants)and products

(A)

RAW MATERIAL UNIT QUANTITY

PER DAY

MS SHEET Kilogram 50

(B)

PRODUCT UNIT QUANTITY PER

DAY

PANEL BOARD Numbers 300

8. In case of manufacture of plastic carry bag/container :

(Plastic Manufacture and Usage Rules)

Types QUANTITY Minimum sizes of Status of compliance with

carry bags(not be Rules 5,6,7&8
les s than 8 * 12)
9. Total manpower:

10. Working season:

11. No. of working days per year: days / shifts

12. Number of staff quaters within the premises:

Number of residents: 4

13. Production process:

(Attach flow sheet and project report)

14. Gross Fixed Capital Investment(Rs in lakhs):

(Rs. in Lakhs)
62.99
AMOUNT(Rs.) MODE OF PAYMENT PERIOD

PART III
WASTE WATER MANA

1. Water consumption details:

GEMENT
SI.No. PURPOSE CONSUMPTION
l/d

1 Domestic 800.0

2. Source/s of water with quantity: WELL,1

3. Effluent treatment details:

S.No Uses Effluent Generation Treatment Arrangement Treatment Details
Status
4. Effluent quantity and quality:

OUTLET QUANTITY QUALITY RECIPIENT

NUMBER m3/d BODY
PARAMETER UNIT
CONCENTRATION

* In case of discharge to land, extent and survey number shall be provided)

5. Recycle/Reuse of treated waste water:

QUANTITY,l/d USE

6. Water Budget:
(Account for difference between water consumption and effluent generated)

7. Details of rain water harvesting :

PART IV

AIR POLLUTION MANAGEMENT

1. Fuel consumption:

FUEL CONSUMPTION USE

tpd/kld

2. Fugitive emission:

SI.No. Sources Control Measures

3. Stack details:

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Stack Materi Dimension Height Source of Emission Fuel
No. al of above
Constr roof
uction level,m
(for
generat
ion
only)
Height Dia Dia Equipment Cap Unit Type Quantity
m met met acit (tpd or
er er y kld)
Top Bott
cm om
cm

4. Emission Details:

Stack Stack Design Concentration in mg/Nm3,at 12% CO2 correction

No. Name. Flow
Nm3/h

PM SO2 NOx CO Others

5. Emission control&monitoring:

Stack Stack Port Platform Ladder On-Line Monitoring Sources Control

No. Name. Hole (Y/N) (Y/N) Measures
(Y/N)

Continuous Periodic
(Y/N) (Y/N)

6. Ambient air quality:

(applicable for large scale red category units only)

Location Air quality, microgram/m3 Sound

dB(A)Leq

SPM So2 NOx RSPM H2S Others D* N*

(D* Day time- 6 a.m to 10 p.m; N* Night time- 10 p.m to 6 a.m.)

PART V

SOLID WASTE MANAGEMENT

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HAZARDOUS WASTE MANAGEMENT

1. Activity for which authorisation is sought:

(tick in appropriate cells)

Collection Transport
Reception Storage
Treatment Reprocessing/Disposal

2. Details of hazardous waste as defined in the Hazardous Wastes Rules:

SI.No. Type of Waste Category Quantity Quality

of waste

3. Mode of Hazardous Waste:

SI.No. Type of waste Mode of

Storage Treatment Disposal

4. Details of Registration Obtained from Central Pollution Control Board:

(In the case waste re-processors/refiners only,attach copy of Registration Certificate)

5. Isolated storage of hazardous chemicals:

(Schedule II of the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989)

Chemical Use Mode of Capacity

Storage in t

6. Whether emergency plans are prepared for taking

*on-site measures Yes/No :No
*off-site measures Yes/No :No

7. NON-HAZARDOUS WASTE MANAGEMENT

Category Quantity Details of storage treatment &

disposal
OTHER PARTICULARS

8. Green-belt details:
(also to be shown in site plan)
9. Details of litigation pending, if any, against
pollutiondue to your establishment:
10. Details of separate energy meters, if provided,
forpollution control equipments:

NA

NA

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11. Details of stand-by power, if provided, for pollution 9 HP control equipments:
12. Any other pertinent matter:

Signature:
Name:

Accompaniments :

1. Copy of Address Proof (Attached)

2. Copy of Land Tax Receipt(Self attested (Attached)
3. Site planing(in A4/A3)showing residences/structures, water bodies, roads etc, within 100m radius of
theindustry(200m in case of crusher industry (Attached)
4. Copy of lease agreement(if in lease (Attached)
5. Affidavit in Rs. 100/- stamp paper or C.A.'s certificate regarding undepriciated value of the fixed assets of
theindustry/project clearly indicating the value of Land, Plant & Machinery and other Miscellaneous Fixed Assets
etc. on a particular date(alongwith a copy of the balancesheet of the industry/project as applicable) (Attached)

INSTRUCTIONS
1. The Application is to be made by the occupier.

2.The application is to be submitted in triplicate to the office of the Board in the District.

3.The duplicate and triplicate copy can be photocopies of the original but copy should have the
signature of the applicant in original.The copy should have copies of accompaniments.

4.State NA if any item is not applicable.

5.If the space provided is insufficient, duly refrenced additional sheets can be used..

6.The gross fixed capital investment shall include the cost of land, building, plant, machinery, etc.
without depreciation upto the date of application. If the land is on lease 20 times of the annual lease
amount shall be taken as cost of land.

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7.Consent fee shall be paid for a period of 3 years. In case fees under Water act, Air Act,BMW
Rules,Plastic rules are already paid for part of the period,proportionate fees for the balance period
are to be paid.For the purpose of calculation of consent fee,part of a year shall be counted as one
year.

8.The consent fees is to be paid in the favour of Kerela state Pollution Control Board.

9.The water consumption in part III shall not exceed that specified in the schedule of the Water Cess
Rules, 1978. In case that is exceeded, the reason thereof is to be stated.
10.The analytical part in Part III and Part IV shall be supported by reports of analysis done by
laboratory approved by the Board.

11.Pollution prevention, control and monitoring facilities may be got designed and installed
preferably by consultants approved by the Board.

12.The following documents are available at the Board offices on request, free of cost.

(a)Chart of consent fee payable.

(b)Categorisation of industries into red/orange/green.

(c)Schedule of Water Cess rules, 1978.

(d)List of laboratories/consultants approved by the Board.

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 Attachment for Compliance with Hazardous Wastes
(Management and Handling) Rules, 1989

Form-I

[(See Rule 2(b), 5(2), (3) and (6) (ii)]

APPLICATION FOR AUTHORISATION/RENEWAL OF AUTHORISATION FOR

COLLECTION / RECEPTION / TREATMENT / TRANSPORT / STORAGE / DISPOSAL
OF HAZARDOUS WASTES

From : SHYLAJA M P
VENGACHUVADU VAZHAKKULAM P O MANJALLOOR PIN - 686670

To,

The Member Secretary,

Kerala State Pollution Control Board

Sir,

I/We hereby apply for authorisation / renewal of authorisation under sub-rule (3) of Rule 5 of the
Hazardous Waste (Management and Handling) Rules, 1989 for collection/ reception/ treatment/ transport/
storage/ disposal of hazardous wastes.

_______________________________________________________________________________________

(FOR OFFICE USE ONLY)

1. Code. No:

2. Whether the unit is situated in a critically polluted area as identified by Ministry of Environment &
Forests :

TO BE FILLED IN BY APPLICANT PART - A GENERAL

3. (a) Name of the Owner/Occupier: SHYLAJA M P

(b) Name and address of the unit and location of activity: PAS ELECTRICALS
,VENGACHUVADU
VAZHAKKULAM P O
MANJALLOOR

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PIN - 686670

(c) Authorisation required for (please tick mark appropriate activity/ activities): HWM

(d) In case of renewal of authorisation, previous authorisation number and date:

4. (a) Whether the unit is generating hazardous waste as defined in the Hazardous Wastes (Management and
Handling) Rules, 1989

(b) If so, the Category No.

5. (a) Total capital invested on the project: 62.99

(b) Year of commencement of production: 2021

(c) Whether the industry works general/2 shifts/round the clock:

6. (a) List and quantum of products and by-products:

PRODUCT UNIT QUANTITY

PER DAY

PANEL BOARD Numbers 300

By-PRODUCT UNIT QUANTITY

PER DAY

(b) List and quantum of raw materials used:

RAW MATERIAL UNIT QUANTITY

PER DAY

MS SHEET Kilogram 50

7. Furnish a flow diagram of manufacturing process showing input and output in terms of products and
waste generated including for captive power generation and demineralised Water.

PART-B
PERTRAINING TO SEWAGE AND TRADE EFFLUENT

8. Quantity and source of water for:

14
 S.No PURPOSE CONSUMPTION

1 Domestic 800.0

Place :ERNAKULAM II Signature

Date :04/08/2021 Designation : proprietor
9. Sewage and trade effluent discharge:

(a) quantum of discharge m3/d

(b) Is there any effluent treatment plant:

(c) If yes, a brief description of unit operations with Capacity:

(d) Characteristics of final effluent pH:

Suspended solids

Dissolved solids
Chemical Oxygen Demand (COD)

Biochemical Oxygen Demand [(BOD5/20oC)]

Oil and grease

(Additional parameters as specified by the concerned Pollution Control Board)

(e) Mode of disposal and final discharge point (enclose map showing discharge point):

(f) Parameters and Frequency of self monitoring:

PART-C
PERTAINING OF STACK (CHIMNEY) AND VENT EMISSIONS

10. (a) Number of stacks and vents with height and dia (m)

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 (b) Quality and quantity of stack emission from each of the above stacks-particulate matter
and sulphur dioxide (SO2) (Additional parameters as specified by the concerned
Pollution Control
Board):
(c) A brief account of the air pollution control unit to deal with the emission:

(d) Parameters and Frequency of self monitoring:

PART-D
PERTAINING TO HAZARDOUS WASTE AND HAZARDOUS CHEMICAL

11. Solid Wastes:

(a) Total Quantum of generation

(b) Quantum of hazardous waste generated and its nature, as defined under the Environment
(Protection) Act, 1986. (See the Hazardous Wastes (Management and Handling) Rules, 1989):

(c) Mode of storage within the plant, method of disposal and any other information sought
by the concerned Pollution Control Board:

12. (a) Hazardous Chemicals as defined under Environment (Protection) Act, 1986 (“See the Manu
facture,Storage and Import of Hazardous Chemicals Rules, 1989):

(b) Whether any isolated storage is involved if yes, attach details

Chemical Use Mode of Capacity

Storage in t
 Yours faithfully,
(c) Whether emergency plans are prepared for taking Name and Signature of applicant
- On site measures : No

- Off site measures : No

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