FORM

Common Application for Consent under

Water (Prevention and Control of Pollution) Act, 197,
Air (Prevention and Control of Pollution) Act, 19!1 and Aut"ori#ation under
$a#ardous Wastes (Mana%ement and $andlin%) Rules, 19!9 as amended&
'o& &&&&&&&&&&
Accompan(in% form in triplicate to )e su)mitted )(
t"e applicant& One cop( ma( )e retained )( t"e applicant&
Explanatory note for filling in application form for
Consent/Authorization
1& An( applicant *no+in%l( %ivin% incorrect information or suppressin% an( ,nformation
pertainin% to an( of t"e items of t"e application s"all )e lia)le for punis"ment as per
provisions under t"e relevant Act&
-& ."e application form s"all )e su)mitted at t"e respective /u) 0 Re%ional Officer of t"e 1oard
under +"ose 2urisdiction t"e applicant3s activit( falls&
4& ."e application s"all )e accompanied )( t"e consent fee in t"e form of 5emand 5raft
in favor of Maharashtra Pollution Control Board& Fee paid is 'ot refunda)le
& For t"e items mar*ed 6 stri*e out +"ic" is not relevant
7& ,f an( of t"e items is not relevant to t"e activit( of t"e applicant, please state 8'ot Applica)le3&
9& ,f t"e space for repl( provided for an( item is inade:uate, use additional s"eets, dul(
referenced&
7& ,tem 1 ; <ive t"e name of t"e person +"o is aut"ori#ed )( t"e applicant to transact t"eir
)usiness&
!& ,tem - ; Also state t"e concerned instructions under +"ose administrative area t"e unit falls&
9& ."e form s"all )e accompanied )( t"e relevant documents specified on t"e last pa%e
of t"e application&
1=& Capital ,nvestment 0Consent fee is to )e paid )ased on %ross )loc* investment of t"e
unit +it"out depreciation till t"e date of application& ."e %ross )loc* capital investment s"all
include cost of land, )uildin%, plant and mac"iner( +it"out depreciation same s"all )e certified
)( C"artered Accountant&
,n case of proposed unit total pro2ect cost s"all )e considered&
Note: ."e from ma( )e %et do+nload from t"e MPC1 We)site; "ttp;>>mpc)&ma"&nic&in
From fee of Rs&1==>0 ma( )e added in t"e current fee in case t"e do+nloaded from is used

0-0
PAYMEN !" C!N#EN "EE#
he fee structure is as under :$
#r
No%
Capital &n'estment of industry
(including land) *uilding)
machinery +ithout
depreciation, r
Consent to Esta*lish Consent to !perate
1 More t"an Rs& 1== Crores =&=1? of Capital
,nvestment
=&=1? of Capital ,nvestment
- 1et+een Rs& 7= Crs& to 1== Crs Rs& 77,===>0 Rs& 77,===>0
4 1et+een Rs& 1= Crs& to 7= Crs Rs& 7=,===>0 Rs& 7=,===>0
1et+een Rs& 7 Crs& to 1= Crs Rs& -=,===>0 Rs& -=,===>0
7 1et+een Rs& 1 Crs& to 7 Crs Rs& 1=,===>0 Rs& 1=,===>0
9 1et+een Rs& 9= @acs& to 1 Crs Rs& 4,===>0 Rs& 4,===>0
7 1et+een Rs& 1= Crs& to 9= Crs Rs& 17==>0 Rs& 17==>0
! 1elo+ Rs&1= @acs Rs& 7==>0 Rs& 7==
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
."e industries "ave )een classified in different cate%ories suc" as 0
-E.) !-AN/E) /-EEN dependin% on pollution potential& ."e a)ove referred consent fee for
Com)ined Consent to Operate is for a period of 1, -, 4 (ears for industries in RB5,
ORA'<B C <RBB' cate%or( respectivel(& ."e industries can opt for multiple period of
consent (maDimum up to five times ) )( pa(in% correspondin% "i%"er fee, su)2ect to t"eir
compl(in% +it" re:uirement of installation of pollution control
facilities&
Fees for @ocal 1odies (under Water (P&C&C& P&) Act,197 onl(&
Municipal Corporation Rs& -=,===>0
EAE <rade Municipal Corporation Rs& 1=,===>0
E1E <rade Municipal Corporation Rs& 7,===>0
ECE <rade Municipal Corporation Rs& -,===>0
Consent fees s"ould )e paid )( +a( of 5emand 5raft dra+n in favour of
EMA0A-A#0-A P!112&!N C!N-!1 B!A-.E onl(& Pa(a)le at t"e $F of t"e
concerned /u)0Re%ional Officer&

010
Application for Consent > Aut"orisation
5ate ;
From &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&Mr& Om Pra*as" Mo"arir&
Partner,&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&/tartec" Mac"ine .ools C Oils&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
.o,
."e &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Ma"aras"tra Pollution Control 1oard,
'as"i* 5ivision&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
/ir,
,>We "ere)( appl( for6 Consent to Bsta)lis"
1& Consent to Bsta)lis">Operate>Rene+al of consent under section -7 and -9 of t"e Water
(Prevention C Control of Pollution) Act, 197 as amended&
-& Consent to Bsta)lis">Operate>Rene+al of consent under /ection -1 of t"e Air (Prevention and
Control of Pollution) Act, 19!1, as amended&
4& Aut"ori#ation>rene+al of aut"ori#ation under rule 7 of t"e $a#ardous Wastes
(Mana%ement and connection $andlin%) Rules, 19!9, as amended in Ganuar(,-===, in
connection +it" m(>our>eDistin%>proposed>altered> additional manufacturin%>processin%
activit( from t"e premises as per t"e details %iven )elo+&
Part A: /eneral
3 'ame, desi%nation, office address +it"
.elep"one>FaD num)ers, e0mail of t"e Applicant
Occupier>,ndustr(>,nstitution > @ocal 1od(
: Mr& Om Pra*as" Mo"arir
99--17!9, 9!--=4171!
"ris"i*es"&d"on%adeH%mail&com
4 (a) 'ame and location of t"e industrial unit>premises for
+"ic" t"e application is made (<ive revenue /urve(
'um)er>Plot num)er name of .alu*a and 5istrict, also
telep"one and faD num)er)
: /tartec" Mac"ine .ools C Oils
A55 ; /& 'o;149>->-, Iil"oli,
.alu*a ; 'as"i* 5ist&; 'as"i*&
()) 5etails of t"e plannin% permission o)tained from t"e
local )od(>.o+n and Countr( Plannin%
aut"orit(>Metropolitan 5evelopment aut"orit(>
desi%nated Aut"orit(
: .o+n Plannin% @etter Re%& 149>->-
'o !79 5ated; -1>=4>-=14
'ame of t"e local )od( under +"ose 2urisdiction
t"e unit is located and 'ame of t"e licence issuin%
Aut"orit(
: <ram Panc"a(at ; Iil"oli,
.alu*a ; 'as"i*& 5ist ; 'as"i*&
5 'ames,addresses +it" .elep"one and FaD 'um)er
of Mana%in% 5irector > Mana%in% Partner and officer
responsi)le for matters connected +it" pollution
control and>or $a#ardous +aste disposal&
: Mr& $ris"i*es" 5& 5"on%ade&
!9, Ovee, Pari2at 'a%ar, 'as"i* =7&
Mo); 99--17!9
0-0
6 (a) Are (ou re%istered ,ndustrial unit J : 'ot Ket&
()) ,f (es, %ive t"e num)er and date of re%istration : Cop( of ac*no+led%ement //, Re%&
7 <ross capital investment of t"e unit +it"out
depreciation till t"e date of application (Cost of
)uildin%, land, plant and mac"iner()& (.o )e
supported )( an affidavit>underta*in% on Rs&-=>0
stamp paper, annual report or certificate from a
C"artered Accountant for proposed unit(s), %ive
estimated fi%ure)
: 79,17,!9 Rs&
8 ,f t"e site is located near sea0s"ore>river )an*>ot"er
+ater )odies>$i%"+a(, ,ndicate t"e cro+ fl(
distance and t"e name of t"e +ater )od(, if an(&
: '& A&
9 5oes t"e location satisf( t"e Re:uirements Lnder
relevant Central>/tate <ovt& 'otification suc" as
Coastal Re%ulation Mone& 'otification on
Bcolo%icall( Fra%ile Area, ,ndustrial @ocation polic(,
etc& ,f so, %ive details&
: '&A&
: ,f t"e site is situated in notified industrial estate, : Proposed ,ndustr( Mone ( .o+n
Plannin%, 'as"i* )
(a) W"et"er effluent collection, treatment and
disposal s(stem "as )een provided )( t"e aut"orit(&
: '& A&
()) Will t"e applicant utili#e t"e s(stem, if provided : '& A&
(c) ,f not provided, details of proposed arran%ement : '& A&
; (a) .otal plot area : 4!! /:& m&
()) 1uilt up area and : 4=9&-7 /:& m
(c) Area availa)le for t"e use of treated se+a%e>
trade effluent for %ardenin%>irri%ation&
: '& A&
3< Mont" and (ear of commissionin% of t"e Lnit& : Ma( -=14
33 'um)er of +or*ers and office staff
Wor*ers /taff $rs& of s"ift Wee*l( off
1 ! /aturda(
:
34 (a) 5o (ou "ave a residential colon( Wit"in t"e premises
in respect of W"ic" t"e present application is Made J
: 'o&
()) ,f (es, please state population sta(in% : '& A&
(c) ,ndicate its location and distance +it" reference
to plant site&
: '& A&

040
35
@ist of products and )(0products Manufactured in
tonnes>mont", Nl>mont" or num)ers>mont" +it"
t"eir t(pes i&e&5(es, dru%s etc& (<ive fi%ures
correspondin% to maDimum installed production
capacit(
: Furnace Oil ; 1== .PM
/teel /crap ; = .PM
Car)on 1lac* ; = .Pm
36
@ist of ra+ materials and process c"emicals +it"
annual consumption correspondin% to a)ove
stated production fi%ures, in tonnes>mont" or
*l>mont" or num)ers>mont"&
: Lsed> Waste Ru))er ; -== .PM
Fire Wood ; -&7 .PM
37
5escription of process of manufacture for eac" of t"e
products s"o+in% input, output, :ualit( and
:uantit( of solid, li:uid and %aseous +astes, if an(
from eac" unit process&
(.o )e supported )( flo+ s"eet and>or material
)alance and +ater )alance s"eet)&
: As per t"e attac"ed flo+ c"art&
Part B : =aste =ater aspects%
38
Water consumption for different uses (m
4
>da()
: 1 m
4
> da(
(i) ,ndustrial coolin%, spra(in% in mine Pits or )oiler
feed, propultion of "(dro %eneration sets
: 7== liter>da(
(ii) 5omestic purpose :
(iii)
Processin% +"ere)( +ater %ets Polluted and t"e
pollutants are Basil( 1io0de%rada)le
:
(iv)
Processin% +"ere)( +ater %ets polluted and t"e
pollutants are not easil( 1io0de%rada)le and are
toDic
:
(v) Ot"er suc" as a%riculture, %ardenin% etc& (specif() : <ardenin% ; 4== liter>da(
.otal 1=== liter> da(
39
/ource of +ater suppl(, 'ame of aut"orit(
%rantin% permission if applica)le and :uantit(
permitted&
: /elf o+ned +ater +ell
3: Fuantit( of +aste +ater (effluent) %enerated (m
4

>da()
: '& A&
(i) 5omestic ; (vi) Coolin% +ater )lo+do+n;
(ii) ,ndustrial ; (vii) 5M Plants>/oftenin%;
(iii) Process ; (viii) .ail race disc"ar%e from;
(iv) Was"in% ;
(v) 1oiler 1lo+do+n ;
3;
Water )ud%et calculations accountin% for
difference )et+een +ater consumption and effluent
%enerated&
: '&A&
4<
Present treatment of se+a%e>canteen effluent (<ive
si#es>capacities of treatment units)&
: '& A&
43
Present treatment of trade effluent (<ive
si#es>capacities of treatment units) (A sc"ematic
dia%ram of t"e treatment sc"eme +it" inlet>outlet
c"aracteristics of eac" unit operation>process is to
)e provided& ,nclude details of residue Mana%ement
s(stem (B.P slud%es)
: '& A&
00
44 (i) Are se+a%e and trade effluents miDed to%et"erJ : '& A&
(ii) ,f (es, state at +"ic" sta%e 0W"et"er )efore,
intermittentl( or after treatment&
:
45 Capacit( of treated effluent sump, <uard Pond if an(& : '& A&
46 Mode of disposal of treated effluent Wit"
respective :uantit(, m
4
>da(
: '& A&
(i) into stream>river (name of river) :
(ii) into cree*>estuar( (name of Cree*>estuar() :
(iii) into sea :
(iv) into drain>se+er (o+ner of se+er) :
(v) On land for irri%ation on o+ned land>ase land&
/pecif( cropped area&
(.o )e supported )( relevant documents
:
(vi)
Fuantit( of treated effluent reused> rec(cled, m
4
>da(
Provide a location map of disposal arran%ement
indicatin% t"e outler(s) for samplin%&
:
47 (a) Fualit( of untreated>treated effluents (/pecif( p$ and
concentration of //, 1O5,CO5 and specific
pollutants relevant to t"e industr(& .5/ to )e
reported for disposal on land or into stream>river&
: '& A&
()) Bnclose a cop( of t"e latest report of anal(sis
from t"e la)orator( approved )( /tate
1oard>Committee>Central 1oard>Central <overnment
in t"e Ministr( of Bnvironment eDpected
c"aracteristics of t"e untreated>treated effluent
: '& A&
Part $ C : Air emission aspects
48 Fuel Consumption Coal @/$/ Furnace
Oil
'atural
<as
Ot"er
/pecif(
Fire
Wood
(a) Fuel consumption (.P5>N@5) ; =&1 .P5
()) Calorific value ;
(c) As" content ? ;
(d) /ulp"ur content ? ;
(e) Ot"er (specif() ;
49 (A) 5etails of stac*
(process C fuel stac*s; 5& <& /et)
:
(a) /tac* num)er(s) 1 - 4
()) Attac"ed to :
(c) Capacit( :
(d) Fuel t(pe :
(e) Fuel :uantit( (N%>"r) :
(f) Material of construction :
(%) /"ape (round>rectan%ular) :
(") $ei%"t, m (a)ove %round level) :
070
(i) 5iameter>si#e, in meters :
(2) <as :uantit(, 'm4>"r& :
(*) <as temperature oC :
(l) BDit %as velocit(, m>sec& :
(m) Control e:uipment precedin% t"e stac* :
(n) 'ature of pollutants li*el( to present in t"e stac*
%ases suc" as Cl-, 'oD, /oD, .PM etc&
:
(o) Bmissions control s(stem provided :
(p) ,n case of 5&<& /et po+er %eneration capacit( in
NIA
Attac" specifications includin% residue
mana%ement s(stems of eac" of t"e Control
e:uipment indicatin% inlet>outlet concentration of
relevant pollutants)
:
49 (1) W"et"er an( release of odoriferous compounds
suc" as Mercaptans, P"orate etc& Are comin% out
from an( stora%es or process "ouse&
: 'o&
4: 5o (ou "ave ade:uate facilit( for collection of
samples of emissions in t"e form of port "oles,
platform, ladderOetc& As per Central 1oard Pu)lication
EBmission re%ulations Part0,,,E ( 5ecem)er, 19!7 )
: Kes
4; Fualit( of treated flue %as emissions and
process emissions& Fuantit( of treated flue %as
emissions and process emissions&
(Specify concentration of criteria pollutants and
industry/process-specific pollutants stack-wise.
Enclose a copy of the latest report of analysis
from the laboratory approved by State
Board/Central Board/ Central Government in the
inistry of Environment ! "orests. "or proposed
unit furnish e#pected characteristics of the
emissions..
:
Part $ .: 0azardous =aste aspect
5< ,nformation a)out $a#ardous Waste Mana%ement as defined in $a#ardous
Waste (Mana%ement C $andlin% ) Rules, 19!9 as amended in Gan&,-===&
.(pe>Cate%or( of Waste as per
/c"edule , /c"edule ,, Ft( Met"od of
Collection
Cat& 'o& .(pe Class .(pe N%>da(
Reception stora%e
.ransport
.reatment
5isposal
Please refer copy of Schedule-I & II attached
090
53 5etails a)out use of "a#ardous +aste :
(i) 'ame of "a#ardous +aste>/pent c"emical :
(ii) Fuantit( used>mont" :
(iii) Part( from +"om purc"ased :
(iv) Part( to +"om sold :
54 (a) 5etails a)out tec"nical capa)ilit( and e:uipments
availa)le +it" t"e applicant to "andle t"e
$a#ardous Waste
:
()) C"aracteristics of "a#ardous +aste(s) /pecif(
concentration of relevant pollutants& Bnclose a
cop( of t"e latest report of anal(sis from t"e
la)orator( approved )( /tate 1oard>Central
1oard>Central <ovt& in t"e ministr( of Bnvironment C
Forests& For proposed units furnis" eDpected
c"aracteristics
:
55 Cop( of format of manifest>record Neepin% practiced
)( t"e applicant&
:
56 5etails of self0monitorin% (source and environment
s(stem)
:
57 Are (ou usin% an( imported "a#ardous +aste& ,f
(es, %ive details&
: '& A&
58 Cop( of actual user Re%istration>certificate
o)tained from Ministr( of Bnvironment C Forests,
<overnment of ,ndia, for use of "a#ardous +aste&
: '& A&
59 Present treatment of "a#ardous +aste, if an( (%ive
t(pe and capacit( of treatment units)
: '&A&
5: Fuantit( of "a#ardous +aste disposal : '&A&
(i) Wit"in factor( :
(ii) Outside t"e factor( (specif( location and enclose
copies of a%reement&)
:
(iii) ."rou%" sale (enclosed documentar( proof and
copies of a%reement&)
:
(iv) Outside state>Lnion .erritor(, if (es particulars of (1
C 4 ) a)ove&
:
(v) Ot"er (/pecif() :
Part E $ Additional &nformation
5; (a) 5o (ou "ave an( proposals to up%rade t"e
present s(stem for treatment and disposal of
effluent>emissions and>or "a#ardous +aste
: 'o&
()) ,f (es, %ive t"e details +it" time0 sc"edule for
t"e implementation and approDimate eDpenditure
to )e incurred on it&
: '&A&
070
6< Capital and recurrin% (OCM) eDpenditure on
various aspect of environment protection suc" as
effluent, emission, "a#ardous +aste, solid +aste,
tree0 plantation, monitorin%, data ac:uisition etc&
(%ive fi%ures separatel( for items implemented>to
)e implemented)
:
63 .o +"ic" of t"e pollution control e:uipment,
separate meters for recordin% consumption of
electric ener%( are installed J
:
64 W"ic" of t"e pollution control items are
connected to 5&<& /et (captive po+er source) to
ensure t"eir runnin% in t"e event of normal po+er
failure
:
65 'ature, :uantit( and met"od of disposal of non0
"a#ardous solid +aste %enerated separatel( from
t"e process of manufacture and +aste treatment&
(<ive details of area>capacit( availa)le in applicant3s
land)
:
66 $a#ardous C"emicals P <ive details of C"emicals
and :uantities "andled and /tored
(i) ,s t"e unit a Ma2ot Accident $a#ard unit as per
Mf%&/tora%e ,mport $a#ardous C"emicals Rules J
(ii) ,s t"e unit an isolated stora%e as defined under
t"e M/,$C Rules J
:
(iii) ,ndicate status of compliance of Rules
7,7,1=,11,1-,14 and 1! of t"e M/,$C Rules&
:
(iv) $as approval of site )een o)tained from t"e
concerned aut"orit(J
:
(v) $as t"e unit prepared an off0site Bmer%enc( PlanJ ,s
it updated J
:
(vi) $as information on imports of C"emicals )een
provided to t"e concerned aut"orit(J
:
(vii) 5oes t"e unit possess a polic( under t"e P@, ActJ :
67 1rief details of tree plantation>%reen )elt
development +it"in applicant3s premises ( in "ectors )
:
68 ,nformation of sc"emes for +aste Minimi#ation,
resource recover( and rec(clin% P implemented and
to )e implemented, separatel(&
:
69 (a) ."e applicant s"all indicate +"et"er ,ndustr(
comes under Pu)lic $earin%, if so, t"e relevant
documents suc" as B,A, BMP, Ris* Anal(sis etc&
s"all )e su)mitted, if so, t"e relevant documents
enclosed s"all )e indicated accordin%l(
:
()) An( ot"er additional information t"at t"e
applicants desires to %ive
:
(c) W"et"er Bnvironmental /tatement su)mitted J ,f
su)mitted, %ive date of su)mission
: Kes>'o
0!0
!& ,>We furt"er declare t"at t"e information furnis"ed a)ove is correct to t"e )est of
m(>our *no+led%e
9& ,>We "ere)( su)mit t"at in case of an( c"an%e from +"at is stated in t"is application in
respect of ra+ materials, products, process of manufacture and treatment and>or
disposal of effluent, emissions, "a#ardous +astes etc& ,n :ualit( and :uantit(Q a fres"
application for Consent>Aut"ori#ation s"all )e made and until t"e %rant of fres"
Consent>Aut"ori#ation no c"an%e s"all )e made&
7=& ,>We underta*e to furnis" an( ot"er information +it"in one mont" of its )ein% called )( t"e
1oard&
71& ,>We enclosed "ere+it" a 5emand draft for RsAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA 5ra+n in favour of Ma"aras"tra
Pollution Control 1oard as t"e fee for Consent>aut"orisation for a period upto
AAAAAAAAAAAAAAAAAAAAAAAAA
Kours fait"full(
/i%nature ;AAAAAAAAAAAAAAAAAAAAAAAAAAAA&
'ame ;AAAAAAAAAAAAAAAAAAAAAAAAAAAA
5esi%nation ;AAAAAAAAAAAAAAAAAAAAAAAAAAAA
Accompaniments :$
1& ,ndeD >/ite Plan s"o+in% t"e surroundin% suc" as villa%e,to+n, river, sea s"ore, .ransport
Routes etc&
-& 5etailed la(out plan of t"e factor( premises s"o+in% structures, +ater suppl( line, storm
drain, se+ers for domestic effluents, for trade effluents, location of effluent treatment and its
disposal and an( ot"er useful information, dra+in%, ta)les etc&
4& Manufacturin% process of eac" product +it" flo+ dia%ram C material )alance&
& @atest Goint Ii%ilance sample anal(sis report&
7& 5etails of air pollution control devices provided or proposed to )e provided&
9& Am)ient air :ualit( report, if availa)le&
7& /mall /cale ,ndustr(3s Certificate>'o O)2ection Certificate from 5irectorate of ,ndustries,
<ovt& Of Ma"aras"tra>5&<&.&5& @icence&
!& ReroD cop( of consent %ranted under Air C Water (P&CC&P&)Acts&
9& .@I of ra+ materials&
1=& <ross )loc* investment certificate from C&A&>audited )alance s"eet&
11& Process flo+ s"eet&
1-& C"emical reactions involved in eac" process&
14& 'OC from local )od( for proposed industr(&
1& Water )ud%et calculations&