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In triplicate) 1. Name and Address of the unit 2. Contact person with designation, Tel./Fax 3. Date of Commissioning 4. No. of Workers (including contract labourers) 5. Consent Validity 6. Validity of Authorisation under rule 5 of the Hazardous Wastes (Management and Handling) Rules, 1989 7. Installed capacity of production in (MTA) 8. Products manufactured Name : (a) (b) (c) Year 1 Year-2 Year-3 9. Raw material consumed (Tones / year) Name : (a) (b) (c) Year 1 Year-.

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