FORM 4: FORMAT FOR SUBMISSION OF RETURNS REGARDING DISPOSAL OF HAZARDOUS WASTE Rule 9(2) (To be submitted to the 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 authorisation 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 |