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Hazardous Waste Return Form 2024

The document is a form for filing returns by the occupier or operator of a facility for hazardous waste management. It provides details like the name and address of the generator, description and quantity of different types of hazardous wastes generated, stored, treated and disposed of by the facility between April 2023 to March 2024.

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a1extrusion2021
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95 views1 page

Hazardous Waste Return Form 2024

The document is a form for filing returns by the occupier or operator of a facility for hazardous waste management. It provides details like the name and address of the generator, description and quantity of different types of hazardous wastes generated, stored, treated and disposed of by the facility between April 2023 to March 2024.

Uploaded by

a1extrusion2021
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Form – 4

FORM FOR FILING RETURNS BY THE OCCUPIER OR OPERATOR OF FACILITY


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

(Period : APRIL 2023 to MARCH 2024)


1. Name and address of the Generator/Operator of Facility : HK LABELS INDIA PRIVATE LIMITED
1463 HSIIDC RAI
2. Name of the authorized person and full address with : Mr. Manoj
Telephone and Fax number
3. Description of Hazardous Waste : Physical form with description Chemical form
(a) Waste Oil/Used Oil (Oily)
(b) Ink Waste (solid)
(c) Cotton waste (solid)
(d) Paper waste (solid)
4. Quantity of Hazardous Wastes (in MT) : Quantity (in MT)
Type of Hazardous Waste Opening balance Generation during Sale / Disposal during Closing balance as
as on 1st April the financial year the financial year on 31st March
Waste Oil/Used Oil (Oily) 0 0 0 0

Ink Waste (solid) 0 0 0 0

Cotton waste (solid) 0 0 0 0

Paper waste (solid) 0 0 0 0

5. Description of Storage of Hazardous Waste : MS DRUMS

6. Description of Treatment of Hazardous Waste : Through Authorized Recycler


7. Details of Transportation of Hazardous Waste : Mode of Quantity
Name & address of Consignee Mode of Packing Date of Transportation
Transportation (in MT)
GEPIL MS Drums Road NA NA

8. Details of Disposal of Hazardous Waste : Mode of Quantity


Name & address of Consignee Mode of Packing Date of Transportation
Transportation (in MT)

9. Quantity of useful materials sent back to the : Name and type of material sent back to Quantity (in MT)
Manufacturers* and others# Manufacturers*
Others#
* delete whichever is not applicable
# enclose list of other agencies

Place: Rai Signature:


Date: 25/04/2024 Designation: Authorized Signatory

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