Form-I APPLICATION FOR CONSENT FOR EMISSION UNDER SECTION(21) OF THE ACT (SEE CHAPTER-11) To THE MEMBER SECRETARY T.S. Pollution Control Board, Paryavaran Bhavan, A3, IE, Sanathnagar, Hyderabad. Sir, I/We apply for CONSENT under section(21) of the Air(Prevention and Control of Pollution)Act,1981(14 of 1981) to make emission from industrial plant owned by (1) or occupied by. (2) Sri A Sampath Rao for a period upto (3) I/We further declare that the information furnished in the Annexure/Appendices and Plans is correct to the best of my/our Knowledge. (4) I/we hereby submit that in case of change either of the point, or the quantity of emission or its quality a fresh application for CONSENT shall be made and until such consent is granted, no chamnge shall be made. (5) I/We hereby agree to submit to the Board, an application for renewal of CONSENT one month in advance of the date of expiry of the consented period for emission, if to be continued thereafter. (6) I/We undertake to furnish any other information with in one month of its being called by the Board. (7) I/We enclosed here fee details. D.D NO. Bank Name Amount(Rs) (8) The Annexure, appendices, other particulars and plans are attached herewith in triplicate. Signature Name of the applicant: Sri A Sampath Rao Address of Applicant: Village, Huzurabad Mandal ,Karimnagar District, Telangana State ANNEXURE TO FORM - 1 CHIMNEY Note: Any Applicant knowingly giving incorrect information or suppressing any information thereto shall be liable for action under the provisions of the Act. While filling this Annexure the applicant shall for such of the items not pertaining to his activity shall state not applicable against the relevant item and shall not leave it blank. 1. (a) Full name of the applicant with address: Sri A Sampath Rao (b) Name and Telephone No. of persons incharge of the premises: 2. (a) Full name of the industrial plant with address: M/S.SRI MAHALAKSHMI AGRO INDUSTRIES AND PARA BOILED MODERN RICE MILLVillage, Huzurabad Mandal ,Karimnagar District, Telangana State (b) Full name and address of the occupier (defined in Sri A Sampath Rao M/s.SRI MAHALAKSHMI the Act ) as Registered with the Director of Factories & AGRO INDUSTRIES & Boilers of the State or with any other competent authority PARA BOILED MODERN RICE MILL of the state. : Bornapally(V),Huzurabad (M),Karimnagar T.S. 3. Give revenue / city survey number of land/ premises for which the application is made stating District/ Mandal and Village. (a) Mandal : Huzurabad (b) Village : Bornapally . (b) Magisterial Jurisdiction of the industry (premises) for purposes of prosecution case under the Act and also the name & address of the Police station under the industry (Premises) falls for all criminal cases connected with the Water Act, 1974 or Air Act, 1981. 4. State month and year in which the industrial plant was 04/11/2017 actually put into commission or is proposed to be put into commission/or the month and year from which the local body is functioning 5. (a) State the civil/Military Defence/Industrial Estate Collectorate etc., under. Whose administrative jurisdiction the occupiers industrial plant is situated. 6.Elevation above mean sea 7.Present use of the Land 8.Indicate the nature of topography Plains Surrounding Plains the site. 9.(a) State whether the industrial plant has been declared Not-Selected as prohibited area. (b) If Yes, State the name of the authority and furnish a certified copy of the order which the area has been declared as prohibited. 10 Which of the following features exist within 20 kilometers radius of the site.: Feature Name Distance(in Km) 11. Is the industrial plant of the occupier closed on Not-Selected Sunday/Holiday 12.State working season per year of the Industrial plant. From Date To Date 13. Climatological & Meteorological Data (1).Indicate the climatic conditions at the site(eg Arid, Semi Arid etc.): (2).Precipitation, yearly average range: (3).Temperature, Seasonal ranges: (4).Average annual speed and direction of wind Humidity/Solar radiation: 11.Raw material used Sl. No. Description Quantity Units 1. Parboiled rice 32 Tons/day 15(a) Products /waste material Sl. No. Name of The Product Capacity Units 1. Parboiled rice 32 Tons/day 15(b) By-Products /waste material Sl. No. Name of The By-Product Capacity Units 16.Complete flow chart giving description and-chemical process if any as per Annexure-I 17. Fuel Consumption in T/day S.no. Types Daily Calorific Ash Content Sulphur Other Specify Consumption Value % Content % in Tonnes 18. Furnaces/Cupolas/Boilers/Others Stack Name Used for Type of Date of Capacity Purpose Method of Quantity of Furnace/cup installation used Fuel Fuel used in olas/Boilers/ charging in Boilers Others Boilers DG set Boilers Husk fired 04/11/2017 3.0 tph Not 125KVA boiler selected 19. Emission control equipment for air pollutants Stack Used For Status Not Nature of Efficienc Capacity Details of Give Any Name Existing the Air y Air detailed other Pollution pollution specificat monitori Equipme Control ions of ng nt System cyclones, facilities Electro available. static Precipita tors, Scrubber s, Sag Filters etc. 20. Atmospheric Emissions (Stacks Details) Stack attached to D.G Stack height Gas Quantity (Units) Fuel Gas temprature Are any Standard of Set Emission prescribed for or adopted by your Industry? DG set 125KVA No (a) Fuel Gas Emissions Stack Used For Type of C fuel/hr Ash % NOx SO2 HCL CO Particulat Name Fuel e matter (b) Atmospheric Emission for Process & Fugitive Sources S.no Stack Name Stack Temperature( Expected Proposed Air Are any Height(in 'C) Quantity Pollution Standard of mtr) Control Emission System prescribed for or adopted by your Industry? (c) Process Emissions Stack Name SO2 CO2 CO NOx Hydrocarbon Particulars Others specify (d) Particulate analysis Stack Name Chemical Give details of Flue Give details of Is there sufficient composition gas sampling Laboratory facilities space available for arrangements available for installing Air analysis of emissions Pollution Control Equipment 21. Solid Wastes Nature Quantity Mode of Disposal 22. Any relevant information not covered in the above items : 23. Water Source S.No. Source Type Source Name Quantity 1. Public Supply borewall 28.0 24. Average daily consumption of water Sl. No. Purpose Quantity Unit 25. Waste Water Discharge : SI.No. Purpose Quantity Units 26.Treatment Features Before Treatment After Treatment 27. State the total quantity of air handled by ventilation equipment so also specify size and No. of equipments installed to be installed (a) Location and Dimension of Outlets (i) Fuel Gas Emissions Stack Type of Quantity S % Ash % NOx SO2 HCL CO Particulat Name Fuel of fuel e matter (ii) Process Emissions Stack Name SO2 CO2 NOx Hydrocarbons Particulars Others Specify 28.Give the following details (a) Total investment in the factory and the year of investment. (b) The estimated expenditure for implementing the project (c) Expenditure incurred to date and process achieved (Physical) for air pollution control, if any and the year/years of investments-along with physical process achieved: (d) Annual operation and maintenance of air pollution control plant. (e) Further action that is being taken by the firm to control Air Pollution. 29.Other relevant information : Place : Signature Date : (Name & Address of the applicant) .