Gujarat Pollution Control Board
Paryavaran Bhavan, Sector-10/A,Gandhinagar - 382010
FORM - 1
[ See rule 6(1) ]
CCA-Fresh - 302948 (DRAFT COPY)
Application required for grant/renewal of authorization for generation or collection or storage or transport or reception or recycling or reuse
or recovery or pre-processing or co-processing or utilization or treatment or disposal of hazardous and other waste.
From : NAVKAR POLYMER Date : 07/02/2024
PLOT/PHASE No., PCB-ID : 94360
SURVEY NO.906/2 PLOT NO.4,PASUNJ-KUBADTHAL ROAD,TALUKA
DASKROI,AHMEDABAD ,
KUBADTHAL - 382430
DIST : Ahmedabad-Vatva, TAL : Daskroi, SIDC : Vatva
To,
The Member Secretary,
Gujarat Pollution Control Board
Paryavaran Bhavan, Sector-10/A,
Gandhinagar - 382010
Part-A : General (to be filled by all)
1. (a) Name and address of the unit and location of facility :
As per Above
(b) Name of the occupier of the facility or operator of disposal facility with designation, Tel, Fax and E-mail :
Not Regd with any TSDF
(c) Authorization required for
COLLECTION, GENERATION, OTHER/MISC., REUSE, STORAGE, UTILISATION
GENERATION, COLLECTION, STORAGE, TRANSPORTATION
(d) In case of renewal of authorization previous authorization numbers and dates and provide copies of annual returns of last three
years including the compliance reports with respect to the conditions of Prior Environmental Clearance, wherever applicable:
2. (a) Nature and quantity of waste handled per annum (in metric tone or kiloliter)
(b) Nature and quantity of waste stored at any time (in metric tone or kilo litre)
3. (a) Year of commissioning and commencement of production : 2023
(b) Whether the industry works : 01 Shift / 02 shifts / round the clock :
01 Shift 02 Shift Round the clock
4. Provide copy of the Emergency Response Plan (ERP) Which should address procedure for dealing with emergency situation (viz.
Spillage or release or fire) as specified in the guidelines of Central Pollution Control Board. Such ERP shall comprise the following,
but not limited to : ATTACH SEPRATE PDF FILE.
• Containing and controlling incidents so as to minimize the effects and to limit danger to the persons, environment and
property;
• Implementation the measures necessary to protect persons and the environment;
• Description of the actions which should be taken to control the conditions at events and to limit their consequences, including
a description of the safety equipment and resources available;
*delete whichever is not applicable
Hazardous 1 - Through XGN N I C
Gujarat Pollution Control Board
Paryavaran Bhavan, Sector-10/A,Gandhinagar - 382010
FORM - 1
[ See rule 6(1) ]
• Arrangements for training staff in the duties which they are expected to perform; and
• Arrangements for informing concerned.
5. Provide undertaking or declaration to comply with all provisions including the scope of submitting bank guarantee in the event of
spillage, leakage or fire while handling the hazardous and other waste. ATTACH SEPRATE PDF FILE.
Part-B : To be filled by hazardous waste generators
1. (a) Products and by-products manufactured (names and product wise quantity per annum):
Sr Product Name NOC Qty CCA Qty Applied Qty Inspection Remark
1 Master Batch (Granules) 300.000 0.000 - M.T 300.000
(b) Process description including process flow sheet indicating inputs and outputs (raw materials, chemicals, products,
by-Products, wastes, emissions, waste water etc.) Please attach separate sheets:
As Per the PDF attached.
Sr Raw Material Name Capacity - Unit / Month
1 carbon black 120.000 - M.T
2 lldpr granules 164.000 - M.T
3 pe wax 6.000 - M.T
4 zinc sterate 10.000 - M.T
(c) Characteristics (waste-wise) and Quantity of waste generation per annum:
Sr Source of Hazardous Waste Catg Qty/Year HW Disposal Management
1 Empty barrels/containers/liners contaminated with hazardous I -33.1 7.200-M.T COL,DEC,OTH,REU,STO,DET
chemicals /wastes
(d) Mode of management of (c) above:
i. Capacity and mode of secured storage within the plant;
ii. Utilisation within the plant (provide details);
iii. If not utilised within the plant, please provide details of what is done with this waste;
iv. Arrangement for transportation to actual users/ TSDF;
(e) Details of the environmental safeguards and environmental facilities provided for safe handling of all the wastes at point (c)
above;
2. Hazardous and other wastes generated as per these rules from storage of hazardous chemicals as defined under the Manufacture,
Storage and Import of Hazardous Chemicals Rules, 1989
Sr.No Name of Chemical Quantity / Unit
*delete whichever is not applicable
Hazardous 2 - Through XGN N I C
Gujarat Pollution Control Board
Paryavaran Bhavan, Sector-10/A,Gandhinagar - 382010
FORM - 1
[ See rule 6(1) ]
Part C: To be filled by Treatment, storage and disposal facility operators
1. Provide details of the facility including:
(i) Location of site with layout map;
(ii) Safe storage of the waste and storage capacity;
(iii) The treatment processes and their capacities;
(iv) Secured landfills;
(v) Incineration, if any;
(vi) Leachate collection and treatment system;
(vii) Fire fighting systems;
(viii) Environmental management plan including monitoring; and
(ix) Arrangement for transportation of waste from generators.
2. Provide details of any other activities undertaken at the Treatment, storage and disposal facility site.
3. Attach a copy of prior Environmental Clearance.
Part D: To be filled by recyclers or pre-processors or co-processors or users of
hazardous or other wastes
1. Nature and quantity of different wastes received per annum from domestic sources or imported or both:
2. Installed capacity as per registration issued by the District Industries Centre or any other authorised Government agency.
Provide copy:
3. Provide details of secured storage of wastes including the storage capacity:
4. Process description including process flow sheet indicating equipment details, inputs and outputs (input wastes, chemicals,
products, by-products, waste generated, emissions, waste water, etc.). Attach separate sheets:
5. Provide details of end users of products or by-products:
6. Provide details of pollution control systems such as Effluent Treatment Plant, scrubbers, etc. including mode of disposal of waste:
7. Provide details of occupational health and safety measures:
8. Has the facility been set up as per Central Pollution Control Board guidelines? If yes, provide a report on the compliance with the
guidelines:
9. Arrangements for transportation of waste to the facility:
I/We, enclose herewith Cash Receipt No./Bank Draft No. YHMP2205700224( *** )
& date : 16/01/2024 for Rs :34375 (In words : Thirty Four Thousand Three Hundred Seventy Five Rupees Only)
Pay Remark : By : 630-Dr. Tallika Patel, SO Dt: 16/01/2024
In favour of the Gujarat Pollution Control Board Paryavaran Bhavan, Sector-10/A,Gandhinagar - 382010 as fees payable
under section 25 of the Act.
Details of Previous CTE & CTO : CEF-67436,30/08/2030 & Valid Upto -
Validity for 5 Years. Fees Paid for 5/5/5 Years. Catg : Green, Scale : Small
*delete whichever is not applicable
Hazardous 3 - Through XGN N I C
Gujarat Pollution Control Board
Paryavaran Bhavan, Sector-10/A,Gandhinagar - 382010
FORM - 1
[ See rule 6(1) ]
Air Amount = Rs. 10000 (Air (Sector) : Small Scale Industry, #Plants : 1, #Inc : 0)
Water Amount = Rs. 7500 (W.C(klpd) : 1.000)
Haz Amount = Rs. 10000 (Haz (Sector) : Small Scale Industry, Haz Waste Catg : 1)
Inward Purpose :
We are Applying for CCA Fresh.
Other Information :
(Samkit Ashokumar Bagrecha, Proprietor NAVKAR POLYMER)
Rate of Authorisation Fee
Sr. No. Category Fee in Rupees (for one year)
1 Common facility for Final Disposal(TSDF)
2 Common Facility for Incineration
3 Large Scale Industry
4 Medium Scale Industry
5 Small Scale Industry
*delete whichever is not applicable
Hazardous 4 - Through XGN N I C
