Part – AGeneral
1.(a)
Name and location of the unit
(b)
Address of the unit
(c)
Registration required for manufacturing of:(i)Carry
bags;(a) petro- based,(b) Compostable(ii)
Multilayered plastics
(d)
Manufacturing capacity
(e)
In case of renewal, previous registration number and date of
registration
2.
Is the unit registered with the District Industries Centre of
the State Government or Union Territory? If yes, attach a copy.
3.(a)
Total capital invested on the project
(b)
Year of commencement of production
4. (a)
List and quantum of products and by-products
(b)
List and quantum of raw materials used
5.
Furnish a flow diagram of manufacturing process showing input
and output in terms of products and waste generated including for
captive power generation and water.
6.
Status of compliance with these rules- Thickness – fifty
micron (Yes/No)
Part – BPertaining to Liquid
Effluent and Gaseous Emissions
7.
(a) Does the unit have a valid consent under the Water
(Prevention and control of Pollution) Act, 1974 (6 of 1974)?If
yes, attach a copy
(b) Does the unit have a valid consent under the Air
(Prevention and Control of Pollution) Act, 1981 (14 of 1981)?If
yes, attach a copy
Part – CPertaining to Waste
8.
Solid Wastes or rejects:(a) Total quantum of waste
generated(b) Mode of storage within the plant(c)
Provision made for disposal of wastes
9.
Attach or Provide list of person supplying plastic to be used
as raw material to manufacture carry bags or plastic sheet of
like or multilayered packaging
10.
Attach or provide list of personnel or Brand Owners to whom
the products will be supplied
11.
Action plan on collecting back the plastic wastes
Name and
SignatureDesignation
Date :Place :
II Brand Owners:
Part – AGeneral
1.
Name, Address and Contact number
2.
In case of renewal, previous registration number and date of
registration
3.
Is the unit registered with the District Industries Centre of
the State Government or Union Territory? If yes, attach a copy.
4.(a)
Total capital invested on the project
(b)
Year of commencement of production
5. (a)
List and quantum of products and by-products
(b)
List and quantum of raw materials used
Part – BPertaining to Liquid
Effluent and Gaseous Emissions
5.
Does the unit have a valid consent under the Water (Prevention
and control of Pollution) Act, 1974 (6 of 1974)? If yes, attach a
copy
6.
Does the unit have a valid consent under the Air (Prevention
and Control of Pollution) Act, 1981 (14 of 1981)? If yes, attach
a copy
Part – CPertaining To Waste
7.
Solid Wastes or rejects:(c) Total quantum of waste
generated(d) Mode of storage within the plant(d)
Provision made for disposal of wastes
8.
Attach or Provide list of person supplying plastic material
9.
Action plan on collecting back the plastic wastes
Name and
SignatureDesignation
Date :Place :
Form - II
[See Rule 13 (3)]
Application Form for Registration of Units Engaged in Processing or
Recycling of Plastic Waste
1.
Name and Address of the unit
2.
Contact person with designation, Tel./Fax /email
3.
Date of commencement
4.
No. of workers (including contract labour)
5.
Consents Validity
a. Water (Prevention & Control of Pollution) Act, 1974;
Valid up to _________________b. Air (Prevention & Control
of Pollution) Act, 1981; Valid up to_________________c.
Authorization ; valid up to ...
6.
Manufacturing Process
Please attach a flow diagram of the manufacturing process flow
diagram for each product.
7.
Products and installed capacity of production (MTA)
Products
Installed capacity
8.
Waste Management:
S. No.
Type
Category
Qty
a. Waste generation in processing plastic-waste
(i)
(ii)
(iii)
b. Waste Collection and transportation (attach details)
c. Waste Disposal details
S. No.
Type
Category
Qty
(i)
(ii)
d. Provide details of the disposal facility, whether the
facility is authorized by SPCB or PCC
e. Please attach analysis report of characterization of waste
generated (including leachate test if applicable)
9.
Details of plastic waste proposed to be acquired through sale,
auction, contract or import, as the case may be, for use as raw
material
(i) Name(ii) Quantity required /year
10.
Occupational safety and health aspects
Please provide details of facilities
11.
Pollution Control Measures
Whether the unit has adequate pollution control systems or
equipment to meet the standards of emission or effluent.
If Yes, please furnish details
Whether unit is in compliance with conditions laid down in the
said rules.
Yes/No
Whether conditions exist or are likely to exist of the
material being handled or processed posing adverse immediate or
delayed impacts on the environment.
Yes/No
Whether conditions exist (or are likely to exist) of the
material being handled or processed by any means capable of
yielding another material (e.g. leachate) which may possess
eco-toxicity.
Yes/No
12.
Any other relevant information including fire or accident
mitigative measures
13.
List of enclosures as per rule
Name and Signature
Designation
Date :
Place :
Form - III
[See rules 13(4)]
Application for Registration for Manufacturers of Plastic Raw
Materials
From: .........................................
...................................
.................................(Name and full address of the occupier)
To
The Member Secretary,
...................... Pollution Control Board or Pollution Control Committee
..........................................
..........................................
Sir,
I/We hereby apply for registration under the Plastic Waste Management Rules, 2011
Part – AGeneral
1.(a)
Name and location of the unit
(b)
Address of the unit
(c)
In case of renewal, previous registration number and date of
registration
2.
Is the unit registered with the DIC or DCSSI of the State
Government or Union Territory? If yes, attach a copy.
3.(a)
Total capital invested on the project
(b)
Year of commencement of production
(c)
List of producers and quantum of raw materials supplied to
producers
Name and
SignatureDesignation
Date :Place :
Form - IV
[See rules 17 (1)]
Format of Annual Report by Operator of Plastic Waste Processing or
Recycling Facility to The Local Body
Period of Reporting:
(1)
Name and Address of operator of the facility
(2)
Name of officer in-charge of the facility
(Telephone/Fax/Mobile/ E-mail)
(3)
Capacity:
(4)
Technologies used for management of plastic waste:
(5)
Quantity of plastic waste received during the year being
reported upon along with the source
(6)
Quantity of plastic waste processed (in tons):- Plastic
waste recycled(in tons)- Plastic waste processed (in tons)-
Used (in tons)
(7)
Quantity of inert or rejects sent for final disposal to
landfill sites:
(8)
Details of land fill facility to which inert or rejects were
sent for final disposal:- Address-Telephone
(9)
Attach status of compliance to environmental conditions, if
any specified during grant of Consent or registration
Signature of Operator
Dated :
Place:
Form - V
[See rules 17(2)]
Format for Annual Report on Plastic Waste Management to be
Submitted by The Local Body
Period of Reporting:
(1)
Name of the City or Town and State:
(2)
Population
(3)
Area in sq. kilometers
(4)
Name & Address of Local bodyTelephone No.Fax
No.E-mail:
(5)
Total Numbers of the wards in the area under jurisdiction
(6)
Total Numbers of Households in the area under jurisdiction
(7)
Number of households covered by door to door collection
(8)
Total number of commercial establishments and Institutions in
the area under jurisdiction-Commercial establishments-
Institutions
(9)
Number of commercial establishments and Institutions covered
by door to door collection-Commercial establishments-
Institutions
(10)
Summary of the mechanisms put in place for management of
plastic waste in the area under jurisdiction along with the
details of agencies involved in door to door collection
(11)
Attach details of infrastructure put in place for management
of plastic waste generated in the area under jurisdiction
(12)
Attach details of infrastructure required, if any along with
justification
(13)
Quantity of Plastic Waste generated during the year from area
under jurisdiction (in tons)
(14)
Quantity of Plastic Waste collected during the year from area
under jurisdiction (in tons)
(15)
Quantity of plastic waste channelized for recycling during the
year (in tons)
(16)
Quantity of plastic waste channelized for use during the year
(in tons)
(17)
Quantity of inert or rejects sent to landfill sites during the
year (in tons)
(18)
Details of each of facilities used for processing and disposal
of plastic wasteFacility-I(i) Name of
operator(ii) Address with Telephone Number or Mobile(iii)
Capacity(iv) Technology Used(v) Registration Number(vi)
Validity of Registration (up to)
Name of the SPC B or PCC
Estimated Plastic Waste generation Tons Per Annum (TPA)
No. of registered Plastic Manufacturing or Recycling
(including multilayer, compostable) units. (Rule 9)
No. of Unregistered plastic manufacturing Recycling units. (in
residential or unapproved areas)
Details of Plastic Waste Management (PWM) e.g. Collection,
Segregation, Disposal (Co-processing road construction etc.)
(Rules 6) (Attach separate
Partial or complete ban on usages of Plastic Carry Bags
(through Executive Order) (Attach copy of notification or
executive order)
Status of Marking Labelling on carry bags (Rule 8) [Specify
the number of units or not complied)complied
Explicit Pricing of carry bags (Rule 10)
Details of the meeting of State Level Advisory Body (SLA)
along with its recommendations on Implementation (Rule 11)
No. of violations and action taken on noncompliance of
provisions of these Rules
Number of Municipal Authority or Gram Panchayatunder
jurisdiction and Submission of Annual Report to CPCB (Rule 12)
Plastic units
Compostable Plastic Units
Multilayer Plastic units
Facility-II(i) Name of operator(ii) Address
with Telephone Number or Mobile(iii) Capacity(iv)
Technology Used(v) Registration NumberValidity of
Registration (up to)
(19)
Give details of: Local body’s own manpower deployed for
collection including street sweeping, secondary storage,
transportation, processing and disposal of waste.
(20)
Give details of: Contractor or concessionaire’s manpower
deployed for collection including street sweeping, secondary
storage, transportation, processing and disposal of waste.
(21)
Mention briefly, the difficulties being experienced by the
local body in complying with provisions of these rules including
the financial constrains, if any
(22)
Whether an Action Plan has been prepared for improving solid
waste management practices in the city? If yes (attach copy) Date
of revision:
Signature of CEO or Municipal Commissioner or
Executive Officer or Chief Officer
Date:
Place:
Form-VI
State-Wise Status of Implementation of Plastic Waste Management
Rules, 2016 for The Year .. Annual Report Format
sheet)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)